The Case of the Refused MRI: How to Navigate a Neurologist's Decision

Many patients feel frustrated when their neurologist refuses an MRI, especially when they are experiencing significant pain. One common response is to threaten legal action, but this is rarely the most effective approach. Instead, it’s essential to understand the reasons behind the refusal and explore other avenues to ensure appropriate care.

Why a Neurologist Might Refuse the MRI

First, it is crucial to examine why your neurologist might refuse the MRI. Is it because you know MRI is a costly and sophisticated test and you have an insurance policy to cover it? It’s important to understand that rushing into decisions can sometimes lead to confusion in medical reports and unnecessary surgical procedures. Overuse of imaging tests can also lead to complications and increased healthcare costs.

The Value of Seeking a Second Opinion

Many healthcare professionals support the stance of the first neurologist, but this does not make them the end-all, know-it-all. Physicians, including neurologists, are human and capable of making mistakes. It is often my recommendation that consumers seek a second and even third opinion to make an educated decision about their care rather than being dictated to by a single physician.

Understanding Diagnostic Testing

Your neurologist might have decided that MRI is not indicated based on your history and current symptoms. Physical therapists (PTs) should not be making diagnoses, as it is not within their job scope and could be a violation of their licensing regulations. Without a detailed history and physical examination, there is no way to determine if these tests are necessary.

Sometimes, it is refreshing to see a neurologist exercising restraint, as I do not see neurologists ordering unnecessary advanced imaging exams without good reason. For example, I recently read about a completely unindicated hip MRI ordered by a neurologist. If you feel strongly that you need an MRI, you can likely find some outpatient imaging centers where you can pay out of pocket for screening MRIs. I used to be a partner in one, and we could scan your hip for 400 or less.

Respecting the Neurologist's Role

It’s important to understand that it is not the neurologist’s job to do what you want; it’s their job to do what they think you need. MRI scans are not a straightforward or cheap investigation. In the UK, for example, there is often a waiting list for MRI scans because resources are limited. Unlike CT scans, these days, MRI scans can take a very long time.

It is not good medicine to perform a scan, or any medical test, on the off-chance that something is there. Good medicine involves using diagnostic investigations targeted to ask a specific question. Since you have not provided any specific reasons to think that your neurologist should warrant such an intervention, it might be best to seek a second opinion to find a balance that serves your needs.

Concluding Thoughts

Threatening legal action should be a last resort. Instead, consider seeking a second opinion, understanding the rationale behind the initial decision, and working together with your healthcare providers to find a balanced approach that meets your healthcare needs. Remember, your health and well-being are paramount, and seeking a second opinion can sometimes provide clarity and peace of mind.