Also, Mafi says, doctors think that ordering the imaging test "will provide the patient some psychological benefit."
3. Financial incentives
MRI machines are costly, as are back surgeries, and when the doctors own the imaging equipment, they're more likely to order an imaging test, Mafi says. "I don't think there's anything intentional, but there's an unconscious bias. And we know that regions that have more MRI machines also have more surgeries. They go hand-in-hand," he says.
In an invited commentary in the same issue of JAMA Internal Medicine, Donald Casey, MD, of New York University Langone Medical Center, suggested that doctors use consistent "checklist-based algorithms" that track patient-reported outcomes to improve how they care for these patients.
Second, Casey recommended that patients have higher out-of-pocket insurance co-payments for imaging associated with back pain.
And third, "perhaps the biggest challenge," he wrote, is all the groups, "that promote self-proclaimed intellectual property-based ownership of interventions (including complementary and alternative therapies)…" but which lack "formal and rigorous quality of evidence evaluations…" need to agree on an "objective, common framework or evaluating the value of individual and combination modalities for back pain.
"It is only by achieving greater concordance on the evaluation of the efficacy of back pain interventions that we can achieve greater concordance on our practices."