People over fifty were born in a world where imaging diagnosis did not exist. Or at least not as we know it now. Imaging tests have evolved a lot in recent decades and have thereby modernized (and changed) medicine. These complementary examinations are today more precise and reliable, painless and easy to acquire.
Additionally, they have become more available. The boom in radiodiagnosis means that wherever you go, all modalities will be available at a fraction of the cost. In a matter of a few days you can undergo several tests; each one will provide accessory information about your health status. In 2024, who doesn't have a couple of MRIs already done?
The use of these tests has reshaped user expectations and medical practice entirely. Many patients come to the office expecting tests to be requested: the more the better. The number of tests requested is sometimes confused with a quality indicator. And one of the most curious effects that these tests have had in our society is that decades ago people perceived themselves to be sick based on their symptoms and not because of the opinion of an external test.
For people over 50 years of age, in whom osteoarticular wear is natural, the topic is especially important, since symptoms are usually more honest than tests in defining the severity of things. In a short time, our relationship with them has changed drastically; and for those who were born before the MRI, I advise a pause and reflection on the subject.
One of the most positive aspects of this diagnostic boom is that the surplus of images has allowed us to detect serious diseases early; sometimes unintentional. Early detection is critical in oncological diseases, for example. The use of these technologies allows us to diagnose incipient diseases, which translates into less invasive treatments and better prognoses. This is exactly where the suggestion (not always appropriate) germinates that, from a certain age, seeing ourselves inside never hurts.
Having clarified the undeniable advantages, the first thing to know before undergoing a radiological examination is that, for each serious disease that is detected by chance; There are also dozens of incidental findings without any significance for their health. We are all different, especially on the inside. Cysts, fatty lumps, small benign tumors, and even ectopic teeth can be traveling companions and go unnoticed throughout our lives. Discovering them should not force us to act on them.
However, these thieves ("incidentalomas", in union slang) motivate hundreds of visits to the doctor's office each year for unnecessary follow-up, biopsies, preventive treatments, waiting rooms, anxiety and stress for the user. User who, before all previous metrics, is like a rose and should not be worried about his health. Thus, the emotional price that we as a society pay for the early diagnosis of one is the anxiety and treatment of many others. This is one of the central ideas of the modern approach to diagnostic imaging.
Screening statistically implies bothering a few to save the lives of a few. Fortunately, it is more likely that you are in the group of those bothered and you have to know this to avoid being anxious, insomniac, feeling sick and being a victim of the conclusions of a radiological report.
The second thing to know is that, from the fifth decade onwards, degenerative processes are more frequent than oncological diseases. When we talk about degenerative processes we are referring to those processes resulting from wear and tear that will inexorably affect us all due to the mere fact of being alive and in a constant process of cellular oxidation. Here we include morning low back pain, tennis elbow, carpal tunnels and that treacherous knee, which we have been carrying for decades. If you're of a certain age, you've got something worn out; and over the years, the wear and tear increases. However, radiological reports include everything that can be seen in the images: both serious diseases and degenerative processes.
It is not always easy to read one of these reports and know what is what. When it comes to degenerative processes: the report describes how our tissues age. To use a simile, imagine an expert visiting our home and reporting when he finds damage: all the small breakdowns, chipped radiators and stained walls in his path, no matter how much these findings affect the habitability of the property.
The radiologist does the expert exercise of describing each drip of wax on a melting candle, when—from a clinical perspective—what is really important is whether the candle stays lit and upright. Like the candle and the house, when our bodies wear out they acquire a certain personality of their own, being a very natural biological process. It is normal, therefore, that the radiological report of a young knee is brief, compared to an older knee where the acquired particularities are described. That reading must be understood as that of an expert file; not as a list of diseases or problems that require solutions.
As if this were not enough, rust, wear, dehydration and erosion have technical names derived from Greek and Latin. In the past, the codex came into the hands of the doctor who, under the protection of symptoms and a story, had to discern the wheat from the chaff. But now, the report will be delivered directly to you, fed to your mobile through one of those modern applications that give you more control over your health. Technical words in rapid succession become an ominous puzzle for the inexperienced reader. It's hard to get a clear idea of what's going on inside. Weeks before your check-up visit you will have the time necessary to search the Internet for every thorny term and grumble about its future. And sometimes the idea is tempting to think that if those terms appear there; one will have something. Don't give in to temptation.
Finally, there is not always a linear correlation between the degree of wear evident on the skeleton and the symptoms that said wear causes on a daily basis. It is the doctor's responsibility to read the hieroglyphs and correlate them with your symptoms. I frequently meet with patients who have barely visible degeneration of the spine and severe symptoms at the expense of bad habits; but also with asymptomatic people who were coincidentally found to have severe degeneration, spondylosis, stenosis, and other pharaohs. But if what the test concludes is a mere anatomical description, but does not necessarily explain how bad one feels, it is unavoidable to open one last melon: what effect does the verdict of a test have on the idea we have of our own health? Since always, humans have been what we tell ourselves. Language is the creator of our reality and naming things makes them more tangible. Here we tremblingly balance the benefit that knowing the state of our tissues brings us, versus risking the spell of suggestion that conjures pathologies in whose absence we surely live better.
Imagine three people. María is very active, she has five herniated discs and she doesn't know it because she doesn't hurt. Pedro only has a hernia, the poor guy has been raging with pain for a month. Finally, Laura, who has no pain, knows that she has two herniated discs from a test she had, so she always takes care. Who of the three perceives themselves to be healthier? Which of the three is healthier? What does it mean to be healthy?
A few years ago I ran into a former colleague of mine, also a spine surgeon, at the end of a conference. While we were chatting, he put his hands on his sore back, so I questioned him. He explained to me that several months ago his back hurt, especially after long hours in the operating room. “I must have a black record,” he sighed, convinced. So I asked him: “Have you been through the tube? Have you already had the MRI?” He opened his eyes, shook his head, and dismissed the idea with a raised hand. “No,” he said, “if I take the test and see what's there, it will become real.”
Undergoing tests can guide us and help us understand what is happening to us. But understanding them as an irrevocable verdict on what happens to us can make us feel old and sick. For most, the conclusions of these tests are informative, but rarely edifying. Therefore, I try to indicate them with a head and recommend caution in their reading. Let us not be so eager to submit to them, unless the ailment poses a challenge to our daily lives. Wanting to name each spring and rusty chip in our machinery is giving rise to the idea that sixty years is an illness. And nothing more false. If not, in the end it will be true that “every day we know more and understand less.”
