PHYSICIAN VARIATION IN DIAGNOSTIC TESTING FOR LOW-BACK-PAIN - WHO YOUSEE IS WHAT YOU GET

Objective. This study examined patterns of diagnostic test use for pat ients with low back pain. Three specific questions were addressed: 1) What tests do physicians recommend for patients with 3 common types of low back pain? 2) Do physicians in various specialties differ in the tests they would order? and 3) How appropriate are physicians' choices of tests, based on current medical knowledge and expert recommendatio ns? Methods. A stratified national random sample of 2,604 physicians i n 8 specialties was mailed questionnaires asking about the tests they would order for hypothetical patients with acute back pain, sciatica, or chronic low back pain. Physicians were also asked which procedures they generally used to evaluate suspected lumbar nerve root compressio n. These responses were compared with guidelines that have been sugges ted by the Quebec Task Force on Spinal Disorders, based on comprehensi ve evaluation of the scientific literature. Results. Approximately 1,1 00 physicians responded to the survey (43% response rate). Magnetic re sonance imaging was the most frequently used procedure for evaluating suspected lumbar nerve root compression, although a majority of neuros urgeons would still use myelography. Neurosurgeons and neurologists we re twice as likely as other specialists to order an imaging study for patients with acute nonradiating pain or chronic back pain. Physiatris ts and neurologists were more than 3 times as likely as other speciali sts to order electromyograms for acute back pain with sciatica or chro nic back pain. Rheumatologists were almost twice as likely as other sp ecialists to order laboratory tests for both acute and chronic back pa in. The reported use of imaging and electrodiagnostic tests was genera lly premature and more extensive than that recommended by the Quebec T ask Force. Conclusion. There is little consensus, either within or amo ng specialties, on the use of diagnostic tests for patients with back pain. Thus, the diagnostic evaluation depends heavily on the individua l physician and his or her specialty, and not just the patient's sympt oms and findings. Furthermore, many physicians may be ordering imaging studies too early and for patients who do not have the appropriate cl inical indications. These results suggest a need for additional clinic al guidelines as well as better adherence to existing guidelines.