A Single Image In Time: What Are You Missing?

Wouldn’t it be nice if medical imaging (MRI, CT Scans, X-Rays, etc) could tell us exactly what was wrong and why we are in pain or what the treatment plan should be to have a quick fix? That would be great. But often, that is not the case. Consider something as simple as a picture of a telephone. What doesn’t this picture tell you about the current state of the phone? Is it ringing? Who’s on the other line? Are there any additional background noises? Is it even plugged in or turned on? There are many additional pieces of information missing that would allow you to know more about that phone and what is going on around it. This can exactly be the same downside of a lot of medical diagnostics. It only tells a piece of “the story”. Sure, an MRI may show a “bulging disc” in the lumbar spine. But what that MRI is missing is often even more important for musculoskeletal diagnosis/treatment: What experiences or preconceived notions does the patient have that will impact the outcome? Does the patient have additional stress about work, family life, or other psychosocial barriers to recovery that may increase the risk of long-term disability and work loss? All those are likely more important than one single image in time (MRI) of a low back bulging disc. This likely isn’t the culprit of the pain anyway and may even pose harms and increased costs. So remember that your medical imaging only contains a piece of the story. What other pieces of important information are missing or being overlooked if we only rely on a single image in time?