To me it's crazy that people are waiting an average of nearly 3 months to get imaging. This is probably after waiting a couple months for their doctor's appointment to get the MRI scheduled in the first place.

[1] [https://getmrifast.ca/mri-wait-times]

I'm also quite fond of pointing out that Canada and the state of California have roughly the same populations.

Canada's population is incredibly spread out, but also concentrated in about 5 major cities.

When I needed an MRI on my brain is was roughly a week, and that was in a smaller (under 100K people) city.

It's a triage system, although I wouldn't want to suffer through a "less important" issue.

Long wait times (6-12 months+) for MRIs (due to a lack of both machines and technicians) are a frequent complaint by Canadians.

I'm a doctor working in a government funded public healthcare system, where there is every incentive for the system to NOT do investigations and procedures where there is a poor evidence base. Yet we still waste $BILLIONs every year on them and the majority of this is driven by patient demand.

I frequently get patients where the evidence is for intervention A - that requires the patient to do N amount of work (for example physiotherapy, strengthening exercises) with slow, but real, results. After 15 years of medical practice I can honestly count on one hand how often a patient has genuinely taken an interest in this approach and committed to it. This sentiment is shared across colleagues. The vast majority of patients want a 'quick fix', even when there is no evidence that a quick fix exists.

So they push for intervention B, creating long waits for patients who would genuinely benefit from seeing the interventionist who offers B, resulting in worse outcomes for that cohort.

As the system is free at the point of access patients can simply 'doctor shop' and see as many doctors that are needed until they get one who agrees that intervention B is what is required.

I think it comes from an assumption that lay people have that the body is a machine and if a part of it is broken it can simply be 'fixed'. The truth is, is that the human body and biology are messy. We can't even define broken in a lot of cases, you can have two people with the same finding on a scan and one is in pain and the other is completely symptom free. People find this concept really hard to understand, but most of biology is happening on a microscopic level for which we don't have tests and scans, which again people find hard to accept, that we do not always have an answer. Human biology is not a solved science, not even close. There is also the whole complicated factor of human perception.

Two people can have the exact same experience but have completely different feelings and ideas about it. For one person, post-nasal drip maybe completely distressing and make their life miserable. Another person may have the exact same level of post-nasal drip but it does not bother them at all and they live their entire life with it without ever consulting a doctor. So what partly drives health demand is a patients tolerance and perception of their symptoms, which can change over time.

Many MRI “abnormalities” are, well… normal. “Age-appropriate” findings on MRI readings are vastly under-appreciated. If you are over 50, have no pain, and place you into an MRI, you have at least a …

A 20% chance of having a meniscus abnormality. An 80% chance of something being listed as an abnormality in your knee. A 10-15% or higher chance of having a rotator cuff tear. An 80% chance of having a disc bulge in your back or neck.

I used to suffer from chronic low back pain. It hurt to get out of bed every day for years. 1-2 years after getting into bodybuilding the pain disappeared and didn’t come back. Not only that, but I’m not physically limited by my back whatsoever.

I’m not suggesting you start bodybuilding. But the things I think that helped was 1) weight training, 2) mobility work / stretching, 3) physical therapy. That combo can be really powerful.

My mother-in-law has spinal surgery last christmas, the pain for her, prior to the surgery, was unbearable so it's hard to justify not running from that into the arms of a surgeon. The surgeon showed exactly what was to repair though so it was simple enough to understand and clear in the way it was going to help her.

About 9 months out from that surgery and she doesn't have anymore pain.

At the least I would heavily consider exhausting conservative treatment first. All but the worst tears can heal on their own, it just takes time and steady effort.

No matter what you choose to do, the adherence to rehab will determine your ultimate outcome.

As an anecdote: Family member has a partial lateral meniscus tear in the knee. Surgery was considered as if successful then returning to running might have been possible. Specialist opinions varied as did their reading of the MRI scans.

After a lot of research there was emerging evidence that long-term, surgery was more likely to result in osteoarthritis. So had to weight up long-term mobility over short-term pain relief and not having a major lifestyle change.

You see professional athlete undergoing surgery the next day, but their income relies on regaining usage as quickly as possible. The alternative is physio exercises to strengthen the supporting muscles and avoiding anything that might cause a re-injury.

He was a regular golfer until last year when the pain got too bad to play through. He just started playing golf again at the beginning of September. He told me after three or so rounds he can’t even tell he had surgery or any previous pain in that shoulder.

He’s had one doctor do his knee surgery and the aforementioned shoulder surgery and he’s really happy with all of their work.

I hope you have as good of an experience as my dad has had.

Example: My town installed an outdoor "grown-up playground" in the nearby park. Probably cost a little over two complicated surgeries. Already saved 10 people from neglecting upper body workout. Just 10 people having a really low-barrier-of-entry gym available to them whenever walking their dog. I suspect its already been cost-effective. Plus, it is reusable and low-maintenance. Try to beat that in the operating room!

While I’m fortunate now to be able to dedicate time to the gym and other physical fitness, this was not always the case.

We lack the societal incentive structure to allow someone working 60-80 hours a week to reduce their workload to physically recover. We do allow that same person to spend 5-10 years income on surgeries which have 4-6 week recovery times.

Sadly I wasn’t in the first five! Thanks anyway.