Magnetic resonance and GPs decisions

I wish to comment on this paper, reporting the results of the DAMASK trial,¹ in which I and my local colleagues participated as orthopaedic surgeons. The paper seems to leave many unanswered questions. There is little or no detail on what orthopaedic treatment was undertaken in either group, or whether the diagnoses made were definitive or speculative.

What is clear is that the change on diagnosis by MRI and orthopaedic consultation was about the same, but that GPs had more confidence in the MRI diagnosis than in the orthopaedic diagnosis. This is an important finding and deserves more attention.

Our GP colleagues do not trust us, and would rather trust an MRI. We could argue the appropriateness of that position with regard clinical diagnosis – MRIs are not always right, and are every bit as operator-dependant as a clinical orthopaedic examination. That lack of faith would be bad enough, but if it is based upon surgical findings and GPs have more faith in an MRI than in the results of an arthroscopy, then orthopaedic surgeons have a real problem. The findings of this study, as discussed, are bland and have completely ignored an extremely important and contentious issue that deserves further comment.