portraits, selfies and other imaging …

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She denies being the artist, although it seems to be a good likeness. OK, maybe I embellished the image somewhat. When her older sister was a toddler, the carpet got covered in black texta. She denied involvement too, but the fact that it clearly spelled TARA was a bit of a giveaway.

We live in an age of documenting so much of ourselves. We take selfies on our phone, we upload them to facebook and instagram. We constantly take photos and update our status to represent how much fun we are having and how rosy our life is.

I think we would all have to agree that the majority of what is portrayed on social media is probably not the whole story. It is embellished to say the least. The words we say and the pictures we post probably have a poor correlation with what is going on with the ‘real’ us.

Medical imaging tends to fall into the same category. MRI’s, CT scans, Xrays….they all attempt to be a portrait of our pain, but in reality often have little correlation with the ‘real’ us.

This isn’t new – health professionals have known it for a long time. The weight of evidence supports the fact that imaging is not clearly related to how likely you are to get pain, how bad it is likely to be, how long it is likely to go on for, how much pain is from ‘wear and tear’  or arthritis, and may in fact increase your chance of a poorer outcome. The majority of us have ‘stuff going on’ if you take a picture of your back with an MRI….whether you have pain or not may be purely coincidental.

Using imaging as a way to reassure someone is less than helpful if that person doesn’t understand the terminology in the report.  Some of the terms sound pretty scary but the fact is that they may really just describe a normal finding. Even seemingly very significant findings such as subluxations and spondylosisthesis dont have a lot of weight linking them to unavoidable back pain.

So why have an MRI? It is a question that you should really think long and hard about. Chances are that having it wont change your medical management plan. But consider the other impacts that it could have. It is not helpful to have a scan report that scares you and leaves you anxious. It is not helpful to have a report that convinces you that there is ‘damage’ that you can do nothing about and leaves you feeling helpless. It is also less than helpful to get a report that says there is absolutely nothing wrong…..because you still have pain right?

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