Medical Testing, Doctors, And “X-Ray Vision”
Boston Celtics basketball player Kendrick Perkins injured his knee during the NBA Finals against the Lakers when he landed awkwardly. Unable to weightbear, he left Game 6 not to return for the following pivotal Game 7.
Based on his mechanism of injury and his physical examination, his trainer reported that he tore his medial collateral ligament (MCL) as well as the posterior cruciate ligament (PCL). More amazingly, this was done without the help of a MRI. Since Perkins was unable to play the final game, there was no urgent medical need to expedite the test, as regardless of the result his season was already done.
How do doctors know what’s wrong without X-ray vision or an imaging test? (Note that Perkins did get a X-ray, but X-rays generally don’t show ligament injuries.) Is it guessing?
It’s our medical training. Getting the right diagnosis relies mostly on the doctor able to accurately understand what happened and what symptoms you noticed. This often gives us a good idea what is going on. Afterwards, we do a physical exam that helps us hone down the number of possibilities to the right answer.
If Perkins had been a regular person playing basketball, he would have told his doctor the following:
“I was playing basketball. Jumped up. Landed awkwardly. I knew something was wrong — I didn’t know exactly what it was, but I couldn’t get up on my own. I couldn’t walk. My whole leg was hurting, and the back of my knee was in pain. I heard something pop, but I didn’t know what it was. It was just painful.”
The doctor examining the knee would have noticed swelling, decreased movement, as well as significant pain on the middle aspect of the knee as well as some give or laxity. Given the mechanism of injury, the history, and the examination, the likely injury is a torn MCL and PCL of the knee.
Yet the public is enamored with technology. Simply talking to a patient, thinking about the problem, and using our hands to examine patients can’t be as good as fancy MRI. Don’t these imaging tests give us the truth? Isn’t more imaging better?
Let’s put the doctor diagnostic skills to the test and compare to what the MRI shows. Getting the right diagnosis did not require expensive solutions. It requires listening and examining. More isn’t necessarily better, yet the public believes it.
To fight the temptation of doing tests just for the sake of doing it, find a stellar doctor. The most valuable doctor is the one that is genuinely interested in you, and avoids ordering tests, procedures, and interventions when not medically necessary. He talks to you to understand what your problem is and performs an examination.
Let’s see if doctors got Kendrick Perkins’ diagnosis right. Perhaps we really do have X-ray vision.
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
Thanks for pointing out that in many cases imaging tests are not needed to make an accurate diagnosis. The general public, and some medical professionals, need to hear this over and over until it sinks in.
Art