Medical Imaging: A Double-Edged Sword

Modern medical imaging technology is an absolute wonder. Like many good things, however, there can sometimes be a downside to it. It goes beyond just the trauma of false positives and the dangers of false negatives, though. In fact, it’s common enough that there’s even a popular (though perhaps overstated) acronym for it; victims of medical imaging technology, or VOMIT.

One thing imaging is often unable to establish is that an abnormal finding on an image is actually RELATED to a given symptom or complaint. For example, fully HALF of those 60 or older with NO shoulder pain show rotator cuff tears on imaging. Yet, if someone were to get some imaging done for shoulder pain, and it revealed a tear, all too often that would mark the end of the investigation, even if the tear were ultimately unrelated. Such an individual may even end up getting surgery for that incidental tear and wondering why their shoulder pain hasn’t improved.

Additionally, patients often become “married” to these incidental findings. By that, I mean they identify so strongly with the diagnosis stemming from the imaging that, if the abnormal finding is either one that they are told can’t be fixed or perhaps requires surgery, they form limiting beliefs around their own healing.

Those limiting beliefs may include such perennial troublemakers as, “I’m stuck with this pain forever” or “This will never stop hurting unless I get surgery”

Admittedly, there’s no easy answer for what to do about this. That said, I have an approach I use with clients when they want to discuss existing imaging results or ask about the possibility of having some imaging done. Barring the presence of red flags that point to serious or emergent conditions, I often prefer a wait and see approach. That is, let’s see what we can do for your issue FIRST. If we can resolve it, perhaps you don’t really need the pictures after all. If we take our best shot and aren’t getting anywhere, then perhaps imaging would be useful. Typically, if my clients fail to see fairly rapid improvement, it’s ended up being because there was a connected underlying pathology such as a tear, fracture, tumor etc. At that point, the likelihood that such a finding on imaging would actually be related to the complaint is much higher.