# Here's what's wrong with health care: MRI for tennis elbow **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [July 30, 2009, 4:10am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752 "2009-07-30T04:10:27Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [July 30, 2009, 7:53pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/21 "2009-07-30T19:53:48Z")
I understand, but if these machines are used less, someone is going to have to pay a heck of a lot more per scan. ---
**Author:** ![Raygun99](https://avatars.discourse-cdn.com/v4/letter/r/6f9a4e/32.png) [@Raygun99](https://boards.straightdope.com/u/Raygun99)\ **Post date:** [July 30, 2009, 8:04pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/22 "2009-07-30T20:04:22Z")
> [@Procrustus](#): > > An MRI costs the imaging company very little to run. The machine, however, costs very much, whether you use it or not. If _MORE_ people would get MRI’s, the per patient fee could be much lower. So, perhaps one problem with health care is the _under use_ of diagnostic tests. This isn’t quite the Broken Windows theory of economics as applied to health care, but it’s quite close. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [July 30, 2009, 8:18pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/23 "2009-07-30T20:18:24Z")
A related problem is that MRI machines may be too widespread. If there are five hospitals in town, do each of them need an MRI machine, or can some of them share? (And then there are the MRI machines in radiology clinics not associated with an individual hospital, or even in a medical clinic.) So the doctors at each of those hospitals is encouraged to prescribe enough MRI scans to amortize the cost. Instead, there needs to be some sort of coordination and perhaps a governing body that decides whether such an expensive machine should be purchased. I know that the State of New York created a commission to decide which hospitals should be made redundant. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [July 30, 2009, 8:21pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/24 "2009-07-30T20:21:35Z")
> [@Hilarity\_N.Suze](#): > > I asked them what an elbow MRI cost. $1465, of which my insurance would pay 85%. Or, if I wanted to self-pay, $460. (So in other words, they are taking advantage of third-party payors by upping the cost.) That is the problem - third-party payors mean that the consumer has no reason to try to contain costs. Needless to say no serious politician has proposed changing this, though McCain at least tried to remove _subsidies_ for third-party payors. ---
**Author:** ![TJVM](https://avatars.discourse-cdn.com/v4/letter/t/b38774/32.png) [@TJVM](https://boards.straightdope.com/u/TJVM)\ **Post date:** [July 30, 2009, 8:27pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/25 "2009-07-30T20:27:21Z")
> [@Procrustus](#): > > I’m not sure it’s “exceedingly warped.” maybe a little warped. Here’s the point. The machines probably cost millions. Say 100 people per month get an MRI, and they each pay $1000. say the cost to run the MRI for 20 minutes is $20 dollars (plus the technician. The technician is there all day anyway, the $20 is insignificant. If 400 people per month used the machine you could cut the cost to $250 per patient and pay off the cost of the investment just as fast. If the problem is that MRI machines are being underused, the best solution is to have fewer MRI machines, not to perform more scans just so your numbers match up to your financial model. In the short run you may be stuck with what you have, but in the long run, providers should only buy another MRI machine if they need to do enough (legitimate) scans to make it worthwhile. I do understand your point, and I think it’s a factor in overcare/overbilling. Once a provider has paid the large up-front cost for the machine, they have an incentive to use it as much as possible, first to pay for it, and then, once it’s paid for, to make a profit on it. > [@filling\_pages](#): > > Doctors (and my parents) have been telling my kid sister for years that her knees hurt because she’s 6 feet tall and active. She got an MRI the other day, turns out she’s needed surgery all along, and now there’s some pretty extensive damage. I think the OP and this story, together, highlight the problem. If the insurance company pays for whatever services providers want to perform, costs get inflated by unnecessary care. If the insurance company says no, you get horror stories about how Little Timmy is suffering because the big bad insurance company won’t pay for his surgery. It’s hard to come up with a system that pays for what’s needed, but not more, in light of everyone’s economic incentives. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [July 30, 2009, 8:35pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/26 "2009-07-30T20:35:05Z")
You know, a friend of mine has been dealing with tennis elbow for several months now, and has found that it really limits her mobility with that elbow. It seems to have caused her a lot of pain and has kept her from doing some things that she wants to do. I’m not saying the OP’s kid necessarily needed an MRI, but canceling all further treatment because she’s irked that they suggested an MRI seems a bit drastic. ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [July 30, 2009, 9:02pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/27 "2009-07-30T21:02:31Z")
> [@Zsofia](#): > > I went in to an orthopedic clinic with a sprained ankle and suspected tendon damage. The doctor had me get an MRI because I run and he wanted to make sure my marathon training wasn’t delayed. It turned out to everybody’s suprise to be a stress fracture. \ Sheesh, they did an MRI before they did an x-ray? ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [July 30, 2009, 9:04pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/28 "2009-07-30T21:04:04Z")
> [@MsWhatsit](#): > > You know, a friend of mine has been dealing with tennis elbow for several months now, and has found that it really limits her mobility with that elbow. It seems to have caused her a lot of pain and has kept her from doing some things that she wants to do. I’m not saying the OP’s kid necessarily needed an MRI, but canceling all further treatment because she’s irked that they suggested an MRI seems a bit drastic. I’m not canceling all further treatment. Baseball season is now over, he’s still playing tennis/taking lessons, but less frequently, and the pain is gone. If it comes back, we’ll revisit the situation. ---
**Author:** ![MsWhatsit](https://avatars.discourse-cdn.com/v4/letter/m/eb8c5e/32.png) [@MsWhatsit](https://boards.straightdope.com/u/MsWhatsit)\ **Post date:** [July 30, 2009, 9:08pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/29 "2009-07-30T21:08:20Z")
Ah, I gotcha. Makes sense. ---
**Author:** ![scr4](https://avatars.discourse-cdn.com/v4/letter/s/59ef9b/32.png) [@scr4](https://boards.straightdope.com/u/scr4)\ **Post date:** [July 30, 2009, 9:27pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/30 "2009-07-30T21:27:18Z")
> [@Hilarity\_N.Suze](#): > > Sheesh, they did an MRI before they did an x-ray? Why would they do an X-ray for suspected tendon damage? 😕 ---
**Author:** ![Astroboy14](https://avatars.discourse-cdn.com/v4/letter/a/df705f/32.png) [@Astroboy14](https://boards.straightdope.com/u/Astroboy14)\ **Post date:** [July 30, 2009, 10:12pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/31 "2009-07-30T22:12:53Z")
> [@lieu](#): > > Steroid injection for me. > “Where does it hurt?” > “Here.” > “You’re done. Next!” > > Quick, effective, and cheap. Granted, there obviously are different levels of injury and perhaps kids should not be given a steroid but the point being thank goodness there are doctors out there that don’t try and game the system. Here’s another thing wrong with our system in the US. When I went to the doctor for tennis elbow, he gave me a cortisone shot… pain gone! It came back 6 months later. Back to the doctor… cortisone shot. Pain gone. It came back 6 months later. Back to the doctor… cortisone shot. Pain gone. Moved to South Korea. Tennis elbow came back, so I went to the doctor and asked for a cortisone shot. He said, “What for? Do this!” and demonstrated a couple of stretches to do. A week later the pain was gone and didn’t come back for about a decade (couple of months ago)… so I did the stretches he showed me again and the pain is gone. We’re too hung up on immediate gratification here, IMO. ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [July 31, 2009, 1:28am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/32 "2009-07-31T01:28:01Z")
> [@scr4](#): > > Why would they do an X-ray for suspected tendon damage? 😕 Every time I’ve had a suspected sprained ankle they’ve done an x-ray. Every time one of my kids has had a suspected sprained ankle they’ve done an x-ray. They did an x-ray on the kid with tennis elbow! ---
**Author:** ![Zsofia](https://avatars.discourse-cdn.com/v4/letter/z/7bcc69/32.png) [@Zsofia](https://boards.straightdope.com/u/Zsofia)\ **Post date:** [July 31, 2009, 3:44am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/33 "2009-07-31T03:44:08Z")
> [@scr4](#): > > Why would they do an X-ray for suspected tendon damage? 😕 They did an x-ray. The stress fracture didn’t show on it - I’ve since read that that’s relatively common. ETA - specifically, they did an x-ray to rule out a stress fracture, amusingly enough. The doctor was surprised as hell, because I didn’t fall or have any kind of twisting injury. The physical therapist said it made total sense after he saw how completely fucked up I am from the waist down, biomechanically speaking. ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [July 31, 2009, 12:02pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/34 "2009-07-31T12:02:08Z")
> [@Procrustus](#): > > put the radiologist on salary. Your other points seem valid. Radiologists generally aren’t hospital employees; they’re in private practice and under contract to the hospital. ---
**Author:** ![Swallowed\_My\_Cellphone](https://avatars.discourse-cdn.com/v4/letter/s/9d8465/32.png) [@Swallowed\_My\_Cellphone](https://boards.straightdope.com/u/Swallowed_My_Cellphone)\ **Post date:** [July 31, 2009, 2:55pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/35 "2009-07-31T14:55:50Z")
Geez, when I was a kid, I screw up a kick playing soccer during gym class. The pain in my knee was so severe, if my eyes had been closed and you’d asked me what happened I would have said “I think my leg got torn off at the knee.” Ice and rest is all I got from the MD. Ditto the tennis elbow from screwing up my strokes learning to play squash when I was 12. Rest, then when it healed up and didn’t hurt anymore, someone showed me how to swing my racket properly. I can’t imagine anyone sending me for an MRI back then. It was always “Rest it, and then we’ll see.” ---
**Author:** ![Zsofia](https://avatars.discourse-cdn.com/v4/letter/z/7bcc69/32.png) [@Zsofia](https://boards.straightdope.com/u/Zsofia)\ **Post date:** [July 31, 2009, 3:00pm UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/36 "2009-07-31T15:00:47Z")
> [@Swallowed\_My\_Cellphone](#): > > Geez, when I was a kid, I screw up a kick playing soccer during gym class. The pain in my knee was so severe, if my eyes had been closed and you’d asked me what happened I would have said “I think my leg got torn off at the knee.” > > Ice and rest is all I got from the MD. > > Ditto the tennis elbow from screwing up my strokes learning to play squash when I was 12. Rest, then when it healed up and didn’t hurt anymore, someone showed me how to swing my racket properly. > > I can’t imagine anyone sending me for an MRI back then. It was always “Rest it, and then we’ll see.” Well, generally people end up at the orthopedic clinic because they’ve been resting it, icing it, compressing it, and elevating it, and it’s been two weeks and it still hurts. ---
**Author:** ![Green\_Bean](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/green_bean/32/1760_2.png) [@Green\_Bean](https://boards.straightdope.com/u/Green_Bean)\ **Post date:** [August 1, 2009, 1:47am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/37 "2009-08-01T01:47:17Z")
> [@Crawlspace](#): > > There are three problems here: first, you’re leaving out the cost of maintenance which is on the order of $1million a year (something about needing special liquids to cool the magnets, a cost I assume that goes up with usage). They’re cooled with liquid helium–very expensive to obtain, transport, and handle. ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [August 1, 2009, 2:04am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/38 "2009-08-01T02:04:04Z")
> [@Zsofia](#): > > They did an x-ray. The stress fracture didn’t show on it - I’ve since read that that’s relatively common. > > ETA - specifically, they did an x-ray to rule out a stress fracture, amusingly enough. The doctor was surprised as hell, because I didn’t fall or have any kind of twisting injury. The physical therapist said it made total sense after he saw how completely fucked up I am from the waist down, biomechanically speaking. X-rays can be “wrong” even when they do show a break. In the ER and at the first visit to the orthopedist, my wrist break showed as straight across, immediately before the “knob” at the end of the radius. My orthopedist said normal OTC pain meds (Aleve) should take care of any pain. Three weeks later, I come in for follow-up x-rays. Cast gets cut off, x-rays done, doctor looks at x-rays then walks into the room: “That’s still bothering you.” That statement was made without getting any report from me - and yes, it throbbed like hell at the end of each day. I was using that hand to write and type, as allowed by him. He showed me the new X-ray - the break actually went up the bone and came out the end of it, such that the broken ends of the bone had been rubbed against by my wrist bones that whole time. It healed properly. 😃 But two sets of x-rays didn’t show the actual configuration until it was well into the process of healing. ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [February 26, 2011, 8:12am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/39 "2011-02-26T08:12:45Z")
I am reopening this zombie thread to report that I just got the bill for the x-ray that they did right before they recommended the MRI. That’s right. I JUST got the bill. Today. The only bill I’ve seen for the x-ray. The x-ray performed on 7-21-09. I and my insurance company paid the charges for the office visit, whatever they were, at the time, I think it was a $25 copay. Since I never got any other bills, I assumed the x-ray was part of the office visit, as I’ve had doctors who do it that way. But no. They’re just…very very slow. I guess their billing department is overwhelmed. Understaffed, or something. It took me fifteen minutes to figure out what it was for. I honestly thought at first it was a case of somebody stealing my identity. Then my brain finally processed the date. ---
**Author:** ![Markxxx](https://avatars.discourse-cdn.com/v4/letter/m/5daacb/32.png) [@Markxxx](https://boards.straightdope.com/u/Markxxx)\ **Post date:** [February 26, 2011, 9:49am UTC](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752/40 "2011-02-26T09:49:24Z")
> [@Lynn\_Bodoni](#): > > Partly this is defensive medicine, but I think that most of it is sheer greed. A lot of people WILL get this done if it’s suggested, and especially if it’s pushed. > > And yes, they are definitely taking advantage of the insurance companies. I agree with this. Too many people will turn around and sue, if something bad did show up. We’d have a thread on how awful the doctor was for not wanting an MRI. 🙂 [Previous page](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752.md?page=1) [Next page](https://boards.straightdope.com/t/heres-whats-wrong-with-health-care-mri-for-tennis-elbow/504752.md?page=3)