Headaches and Neuroimaging - High Utilization and Costs Despite Guidelines

[cbrons]

Wondering if anyone saw this recently and what your opinions might be:

http://archinte.jamanetwork.com/article.aspx?articleid=1835347

"While most headaches are attributable to benign conditions, patients and physicians are often concerned about intracranial pathologic conditions. However, the yield of significant abnormalities on neuroimaging in patients with chronic headaches is 1% to 3%.1- 3 Given the comparable yield in patients without headaches, multiple guidelines have recommended against routine headache neuroimaging,4- 6 and efforts to improve the efficiency of health care utilization, such as the Choosing Wisely campaign (ABIM [American Board of Internal Medicine] Foundation; http://www.choosingwisely.org), have identified these tests as a target. However, little is known about recent headache neuroimaging utilization, associated expenditures, and temporal trends in the United States."

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[neurodoc]

This is a "problem" only because MRI is so costly. If MRI's were cheap, there wouldn't be a "heathcare" issue.
MRI is relatively safe...no exposure to ionizing radiation, and it is certainly a very good way to "rule out" serious
conditions that can cause HA.

I agree that the majority of HA patient's don't really "need" a brain MRI, and I say this as a neurologist who has been
practicing for more than 20 years. Ideally, a competent physician presented with a HA patient would perform a thorough
history and physical exam and order an MRI only if the H&P indicated that there was a decent possibility that there was
some significant brain pathology that could be causing the patient's HA.

Unfortunately the medicolegal climate in the USA promotes the practice of "defensive medicine," where physicians are fearful
that they may "miss" a serious problem and to avoid exposure to malpractice liability order "unnecessary" tests.

I wish that this were not the current state of affairs, and that physicians would be allowed to exercise their clinical judgment, but
that is just not the case in the USA at this time.

It's all well and good for the JAMA and other folks to lament unnecessary HA MRI's. It's about time that they address the real
issues that prompt practicing physicians to order "unnecessary" tests.

 

[typhoonegator]

Well said.

 

[bustbones26]

Wondering if anyone saw this recently and what your opinions might be:

http://archinte.jamanetwork.com/article.aspx?articleid=1835347

"While most headaches are attributable to benign conditions, patients and physicians are often concerned about intracranial pathologic conditions. However, the yield of significant abnormalities on neuroimaging in patients with chronic headaches is 1% to 3%.1- 3 Given the comparable yield in patients without headaches, multiple guidelines have recommended against routine headache neuroimaging,4- 6 and efforts to improve the efficiency of health care utilization, such as the Choosing Wisely campaign (ABIM [American Board of Internal Medicine] Foundation; http://www.choosingwisely.org), have identified these tests as a target. However, little is known about recent headache neuroimaging utilization, associated expenditures, and temporal trends in the United States."

As noted prior, the mediolegal environment dictates neuroimaging. For the 1 to 3%, the significant findings are SIGNIFICANT.