by: Dr. Michael A. Castillo
I have a medical pet peeve lately, physicians relying on MRIs and EMG to make diagnoses, without performing a physical exam. Medicine is an honor to have a career in because you get to touch people physically and emotionally. It comes with a great deal of responsibility. I am getting more referrals where a patient hasn’t been physically examined. The patient tells me what is wrong in the history because the MRI says so. The proper order is History, Physical Examination, and then Tests (MRI, X-rays, Nerve Tests, et al) to create a diagnosis. A mentor once said, “Don’t order a test if it is not going to change what you are going to do, and know what you are going to do with the test results.”
Most patients won’t say, “butt;” they say lower back or hip when referring to pain in the lower abdomen. The MRI has a disc bulges at L45 and L5S1. The medical professional says three epidurals. The problem is without a history and physical exam you missed possibilities of what the real problem could be; which includes sacroiliac joint disease, piriformis syndrome, degenerative hip disease, urinary tract infection, lipoma, or post herpetic neuralgia (shingles). Those are a lot of medical terms and possibilities for what a condition might be. Don’t let a physician stick a needle in you without he or she performing a physical exam.
