Evaluation of history taking status and diagnostic and therapeutic measures before applying spine MRI

Abstract

According to increasing use of clinical facilities such as MRI to diagnose diseases around the world, it is important to know that to what extent these facilities are used based on the existing indications. Accurate history taking and physical examination are essential and first step in requesting para-clinical measures. It is also very important in interpreting the spine MRI findings in patients with back pain. Therefore, it seems necessary to examine physicians' attention to history taking and physical examination before applying MRI to enact rules for optimal use of existing facilities. A total of 195 outpatients referred to the Imaging Center of Shahid Sadoughi Hospital in Yazd for spine MRI were selected by easily and convenience sampling method. The data were collected using a structured interview. Of 195 patients referred, 17.5% (n = 31) and 8.2% (n = 16) reported that the physician was not aware of the main complaint duration and the exact pain localization, respectively, and 31% of patients had not been examined by the physician. Based on the results of this research, inattention of some physicians to accurate history taking and physical examination is one of the reasons for aberrant spine MRI. Accordingly, lack of attention to the absence of clinical signs consistent with the results of MRI can create a chain of futile diagnostic and therapeutic measures as well as financial and psychological burden on the patients.The results showed that solving the problem of aberrant requests for MRI requires fundamental and comprehensive planning to develop national guidelines, inclusion of these guidelines in educational system of medical students and doctors, encouraging patients to ask physicians about the reason for applying MRI and its impact on diagnostic and therapeutic processes, and finally national legislation and insurance to monitor and reduce requests without indications.