The Antisocial Doctors Podcast

Episode 9: Should We Be Getting Full Body MRIs?

• Sonia Singh

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 58:05

In this episode, we dig into the viral trend of full-body MRIs and why so many people are drawn to them—especially in an era of rising health anxiety, overwhelming health messaging, and frustration with barriers in the healthcare system. We unpack the kinds of promises people are hearing online, why the “peace of mind” narrative is so compelling (and flawed), and what questions we think are worth asking before buying into any one-click health solution. We also reflect on what this trend reveals about gaps in communication and transparency in traditional medical care, and how we can do better supporting informed, values-based decisions.

00:00 Podcast Mission Intro
01:25 Why This Episode
02:27 Full Body MRI Claims
05:03 Why It Went Viral
10:41 When Screening Helps
16:26 Whole Body MRI Limits
21:29 How Tests Prove Value
26:23 What Studies Actually Show
30:10 Verification Harms
30:44 False Negatives Explained
31:46 Informed Consent Debate
34:04 When Findings Spiral
39:07 Outcomes Over Findings
40:29 MRI Risks And Limits
43:57 Company Study Breakdown
49:22 Doctor Patient Takeaways
52:26 Better Results Communication
54:33 Resources And Red Flags
56:19 Final Disclaimer

📖 Read the full episode summary, sources, and resources on our Substack:
 👉www.theantisocialdoctors.com

Sonia Singh MD

You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety

Rebecca Berens MD

and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.

Sonia Singh MD

We're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.

Rebecca Berens MD

This podcast is meant to be the antidote to your doom. Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion. That comes from social media's messaging around health. In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.

Sonia Singh MD

This is not your average debunking podcast. We wanna explore not just what is trending on social media, but why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.

Rebecca Berens MD

We're so glad you're here. Hi Rebecca. Hi Sonia. How are you doing today? I'm hanging in there. How about you?

Sonia Singh MD

Same girl. Same. Today we're talking about a topic that I've gotten a lot of questions about on social media and from patients. And so I'm really excited to review it with you. Tell us about the story that inspired this episode.

Rebecca Berens MD

Yeah, so I think we've actually both had this experience where I actually had a patient who sent me their report after having had one of these done. We hadn't talked about it beforehand. And I'd heard of these, I'd seen them advertised on the internet, but I didn't really. Know much about them. I hadn't really thought much about it.'Cause it just seemed to me unnecessary. But after I saw okay, like I now know people who are getting these done. I really need to educate myself about what is being marketed, what is being explained to people about these studies? Why are people choosing them? How can we help them make an informed decision about doing this sort of thing? And how can we respond to, I'm sure you've also experienced this, the deluge of ads that we all get for these studies on the internet. So that's the story that brought me to this topic.

Sonia Singh MD

So what is the claim around full body MRIs?

Rebecca Berens MD

Yeah, so I pulled some claims directly from testimonials that I saw on social media and on company websites. We're not gonna name any names of any companies here, but testimonials that were placed. And I think important to mention that underneath all of the testimonials and all of the partners they did receive a free scan. In response or in exchange for their testimonial. So I think that's just an important good

Sonia Singh MD

catch note,

Rebecca Berens MD

To keep in mind that they did receive something for their testimonial.'Cause how could you make a testimonial if you hadn't had the scan, right? But anyway couple things that I saw repeated over and over again in these testimonials. One of them was this MRI helped me catch this serious medical condition that otherwise would've been missed. And I was able to treat it earlier and it improved my outcome. There was one person that claimed they had a cancer that was caught that, and it improved their likelihood of a cure from 20% to 90%. I was like, that's pretty compelling. I'm not sure how we are predicting that but compelling sounding story. Yeah. And then the other common theme that I heard was this claim of I did this, and now I have peace of mind. I know that I'm okay because I've done this test, I've had this very thorough evaluation, so now I have peace of mind that I'm healthy and everything's fine. So those are the sort of like recurrent themes of the claims that I saw. And then, just in terms of what the actual advertised claims are there's one company that I saw whose claim of advertised benefits was that we are assessing your head, neck, chest, abdomen, pelvis, and legs to look for solid tumors, spine degeneration, and other problems, metabolic disorders, non-cancerous conditions brain aneurysms and autoimmune disorders.

Sonia Singh MD

Ooh. I have so many problems with this list already. Okay.

Rebecca Berens MD

So that is actually from the company claims,

Sonia Singh MD

okay. I think my general gal is that. The advertising for these companies makes you feel like, okay, you're gonna get a really thorough head to toe screening for bad stuff. Yeah. And

Rebecca Berens MD

anything that's wrong with you, we'll find it.

Sonia Singh MD

We're gonna find it, and your doctor will never offer this to you, which is an interesting question to explore. But yeah, I think the peace of mind piece is really big for a lot of patients I talk to.'cause by, if they've already, if they're already talking to me, then they have access to healthcare and they've done a lot of things. And so to them this looks like an added layer of security, knowing that there, everything's okay. But yeah, I would definitely wanna come back to this list at some point when we talk through the facts. Okay. So what do you think, we're already talking about it, but what do you think has made this so viral at this point in time? This

Rebecca Berens MD

full

Yeah.

Sonia Singh MD

Idea of doing a full body MRI.

Rebecca Berens MD

So we've talked about this ad nauseam on this podcast, health anxiety is at an all time high. And I think especially with social media, what you do see a lot of on social media is you hear stories of people whose lives were rocked by some surprise diagnosis. Yeah. And this horrible thing happened to my family. You see the GoFundMe, you see these horrible things and you're like, oh my gosh, that would be so terrible. How can I prevent that happening to me? And I think we get targeted these stories because they are so emotional. They, they garner a lot of engagement and so they get shared and the algorithm prioritizes them. And I don't know, for me in particular, when I was spending a lot of time on Instagram, I got targeted a lot of Instagram widow content. I don't know if you've ever had this content targeted at you. Yeah. I mean there's actually quite a few widow influencers on Instagram and. Some of them, their husbands had a sur some of it was an accident, but some of them, it was like a surprise health diagnosis. That came out of nowhere. And it's you hear these stories and you're like, oh my gosh, how can I avoid that happening to me? Yeah. Makes sense that then you're looking for that, the solution. What is the thing I can buy that will prevent me having to experience that? I think also. As we've also talked about many times in this podcast, people struggle with navigating the healthcare system and getting even the basic needed screenings that we do recommend from a public health standpoint and from, our specialty guidelines. There's a lot of barriers. You have to, have insurance coverage for it. If you don't have insurance coverage for you, for it, for some reason, you don't have insurance, you have to pay cash for it. If you have certain insurances, you have to go through a really lengthy and annoying referral process to be able to access your your screenings. If you have an HMO for example, you have to go to make sure it's the right PCP and they sent you to the right place and they put the right referral and the right insurance portal, that process alone can take a couple of weeks. You have to have time to go to these appointments. For for many people you actually have to go to multiple different doctors to get your screenings. If you're a female, maybe you. See a primary care doctor that doesn't do pap smear. So then you're also seeing a GYN and then you're also being referred to a gi for a colonoscopy, and then you're also being referred over to get your mammogram. This is multiple days and time of, out, of your life that you have to spend doing this. So it's just the barriers that people experience and feeling like so much to do on top of everything else that we have to do. And then I think also when you do finally get to that appointment, you just get okay go do this stuff. And there's not a whole lot of discussion about it. It's, and I think people feel like they don't have a full understanding of why am I doing this? What is the value of doing this? What do the results mean? I could see how then you're like, oh, here's this, head to toe exam, we'll find everything. Yeah. And you're like, oh, great. Ignore all that stuff. Just knock it all out in one day, and then now I have peace of mind and there's, and all the stuff that you couldn't screen me for this also will screen me for. I think that's, I was gonna

Sonia Singh MD

say, I think that last piece is a big one because I think with the explosion of all of this, health and wellness information online and on social media, and also just all of this new, I feel like there's this whole, the Medicine 2.0, the medicine 3.0, the biohacking they all have this tone of. Oh, what you're getting in with your doctor, your traditional doctor's office is just barely, you're just barely scratching the surface. There's so much more that, needs to be looked at and tested. And so I think that sentiment has just grown with with social media and the explosion of kind of just access to information. And so people have this sense that yeah, even if you are doing the screenings that your doctor recommended, maybe that's not enough. And as you said, when you're served all this content that makes it seem like everyone around you is dropping dead of some crazy thing that they didn't see coming. I think, being diagnosed with any kind of terminal illness or something really serious is scary no matter what. But I think what's even scarier to people is the idea that I thought this was normal or I thought I had no problems, or I thought I was healthy. Yeah. And then this thing happened, that is terrifying.'cause then people who are like, I have no reason to believe I'm sick. Suddenly. Are afraid that they might be, yeah. And so I think this prevents, presents like a really, a very simple, viable, clickable, one time in and out solution for that. And before. Before these new companies cropped up. My mom who has terrible health anxiety, would go to India like every couple of years to get her full body scan. I think she was getting a CT, to be honest, but she was very much oh, here, you gotta prove everything. You gotta have so many reasons. And justifications and insurance denies everything, but I, you just go over there and you can get whatever you want. So I just get my whole body scanned and, I think that speaks to this this underlying belief that here everything is just gate kept, and the reason the reasons people are not ordering that for you are not just because they don't think it would be helpful or it may be harmful, or it's just oh, it just costs too much money and there's not enough resources, and the insurance's not gonna prove it. And basically all these other reasons that are not really that valid to the patient from the patient point of view. Yeah. And yeah, I think that sentiment again, since the COVID pandemic and just the general distrust that has arisen towards the medical community, I think that sentiment of oh they're gatekeeping, they're preventing us from getting these screenings that may be helpful because they're expensive or, they're just behind on technology.

Rebecca Berens MD

Yeah.

Sonia Singh MD

I think all of that plays into why people jump for this.

Rebecca Berens MD

Yeah. Yeah.

Sonia Singh MD

So what, tell us about what the truth is. What's the negative truth in all of this? What can full body MRIs potentially be helpful for?

Rebecca Berens MD

Yeah I'll start with just the idea of screening in general. There, there is a true benefit to screening when you do not have symptoms for certain conditions. And, there are numerous guidelines that come from specialty organizations and government organizations in every country that. Have weighed the risks, benefits, costs. Outcomes, all of that of various screening tests. And there are tests that we do, even if a person is not having any symptoms to try to catch an illness at an earlier and treatable stage. That concept is obviously true. And I think our public health campaigns about this have been very effective at convincing people that they should have screenings. So like pap smears, for example. I think everyone is very aware that they should be getting pap smears and that there's benefit to getting pap smears. Even just a blood pressure screening, blood pressure is, we call it the silent killer. It's one of the thi those things where you don't know you have high blood pressure until you check it and by the time you're feeling symptoms from the high blood pressure, it's already likely causing you some problems. And so it's there is this, the concept of screening is true. There are some things that it is worth going and getting checked even if you feel fine. So the concept of screening is true. And for whole body, MRII, I wasn't very familiar with the concept because it's not something that as a primary care physician I'm ever really ordering. But there are evidence-based guidelines in specific situations for using whole body MRIs for screening. So I found a a narrative review from the American Journal of Radiology Clinical Applications and controversies of whole body MRI. And so according to this article, the strongest evidence supporting this was for patients with leaf arm mini syndrome. It's for adults with high risk high risk of developing malignancy for some children. So children with malignancies such as Ewing sarcoma, adults with oid lipos sarcoma, pregnant patients with a cult or newly detected malignancy. So there are cases where whole body screening for cancer may be relevant for some patients in some clinical situations. There's also some clinical situations that are not for cancer screening, but for other disease monitoring or diagnos diagnosis. Chronic non bacterial osteomyelitis, myopathy, inflammatory arthritis, and fever of unknown origin were all listed as potential conditions where a whole body MRI may be helpful. So it's not to say that the. Idea of doing a whole body MRI is always wrong. There are some evidence-based situations where it makes sense, but none of these are screening an average risk population. These are all specific clinical situations, patients with specific conditions or specific risk factors. And I think that that was new information for me that I actually did not know. And then I think the other nugget of truth, which we've alluded to is there are a lot of conditions that we don't have specific screening tests for that could potentially be handled differently with a different outcome if we caught them at an earlier asymptomatic stage. Like pancreatic cancer, for example, is one that I think of where you hear all these stories of people who don't have symptoms of their pancreatic cancer until they have a very advanced cancer that is not treatable. And. There have certainly been people who have had incidental pancreatic cancers found at an early treatable stage because they happen to get imaging for some other reason. I had a patient like this actually years ago. And it was, it was just, it was remarkable. I was like, oh my gosh, I've never seen a pancreatic cancer that was treatable. They had they had surgery and they, and it was resected and they did really well. And there are these cases, but again, how do we determine who that is appropriate for, and how do we balance the risks and benefits, which is what we'll get into later.

Sonia Singh MD

Yeah. That's interesting. So it's, it's helpful to know that. Whole body MRI is useful in certain clinical scenarios. It's just clinical scenarios that you and I don't encounter terribly often.

Rebecca Berens MD

Yeah.

Sonia Singh MD

Don't apply to, the vast majority of the population. Yeah. And when you're thinking about any type of scan from an, I guess just to educate, the nonmedical listener, it's like there are indications for each and every test, whether it's imaging or labs or whatever. And it's funny, it just, the whole concept of just scanning somebody head to toe with MRI, strikes me as a little like cave manish, it's just yeah. Just scan the whole body. That makes sense. And I think when you hear about, especially, I'm glad you mentioned pancreatic and ovarian,'cause I get questions about this all the time. It's like, how can I screen myself? Can I just get an ultrasound? Can I just, can we just scan it just in case, and I try to remind people if doing these imaging studies periodically. Detected enough cancers or changed the outcomes, changed, mortality changed. If it changed the trajectory of that disease and was able to do that, then there would probably be some screening around it. And so the fact that it, there isn't, it's not just that no one has ever thought why don't we just, why don't we just scan somebody's whole body once a year? It's probably because it's, that's determined to not have those outcomes or to not be worth the potential harms of doing that, which are hard to, I think are hard to really appreciate when you have not had a lot of experience with the medical system.

Rebecca Berens MD

Yeah. And we'll get into all of the details on that issue specifically when we get into the facts section. But to your point about the. Cave minish. It reminds me, have you seen the movie Idiocracy?

Sonia Singh MD

Oh, of course, yes.

Rebecca Berens MD

Okay. Where I'm like, okay, so we're actually there now. That's the point of Idiocracy that we have arrived at.

Sonia Singh MD

Yeah. Where he just goes in that tube and like all of these things come and they scan his whole body. Yes.

Rebecca Berens MD

Yeah. That's, yeah. So

Sonia Singh MD

that's

Rebecca Berens MD

where we are.

Sonia Singh MD

It's ironic to me that it's it is like this high tech startup kind of vibe,'cause there's nothing high tech about this. They're just like, let's scan somebody, let's just scan their whole body and see what's there. Yeah. So anyway, yeah. The concept is not particularly revolutionary. Yeah. Okay. So tell us a little bit about the facts with a little bit more context and nuance.

Rebecca Berens MD

Yeah. I wanna start with the disclaimers from one of these companies. Their own disclaimers, which are, in the fine print at the bottom of the website. Really hard to see. Not front and center, like all of the,

Sonia Singh MD

of

Rebecca Berens MD

course, testimonials with all the happy patients who received a free scan.

Sonia Singh MD

Yes.

Rebecca Berens MD

But I think this is important and I think is what is not I've never seen really addressed in any of the sort of promotional content that I've seen for these things. So it is specifically supposed to be an adjunct to, but is not intended to replace other evidence-based screenings. It may not detect some very small cancers. It generally can identify cancers once they're approximately one centimeter in size, but it depends on the organ and the appearance of the organ. And that cancer under MRI, whether it's detectable, even at that size it cannot detect lesions in the lining of body parts, including the mouth, nose, throat, gastrointestinal tract, which is where, especially like colon cancer for example, like you're not seeing big masses initially when you're catching early screenings. When you get a colonoscopy, you're seeing a small mucosal lesion, you're not seeing a big mass. As with many tests, there are limitations which may make it impossible to detect all malignancies and disease conditions. It does not evaluate the heart or heart vessels, which again, when you're. Imaging the chest, you think my heart's in there, but is it really giving you imaging of that does not evaluate detailed lung micro architecture or pulmonary micro nodules? So lung cancer is one that's hard to screen for, although there is a screening for it. But, specific risk factors and guidelines around that. This is not as good as that. Established screening method for that. It does not replace dedicated breast imaging for screening or diagnostic evaluation. It's limited in evaluation of the GI tract. Does not replace endoscopy or endoscopy. Limited in assessment of large joints. Should not be considered a primary screening modality of the skin. Does not visualize smaller brain vessels. So you can have, a small aneurysm or narrowing of a blood vessel that may not be seen well on this imaging. So point being like this is a sort of. Rough view. That may pick up some things, but the more detailed stuff and as you'll hear so breast cancer, cervical cancer, colon cancer, some of the biggest cancers that are most common and kill people not detected by this test.

Sonia Singh MD

Those

Rebecca Berens MD

are all

the

Sonia Singh MD

tough

Rebecca Berens MD

ones, basically. And and some small, early things may not be caught either

Sonia Singh MD

and then they're telling you that this is not equivalent to having a breast MRI with contrast. Which is what high risk women often will be getting, and then it's not equivalent to getting a low dose ct, which is what high risk people for lung cancer would be getting.

Rebecca Berens MD

Yeah.

Sonia Singh MD

And it's interesting just their wording too. It's not, it says can serve as an adjunct too, like they're really hedging here. They're like, do all your normal stuff, but then also come and get this thing maybe.

Rebecca Berens MD

Yeah, and I think it's important when we're talking about these disclaimers, like why is this so when you get a full body MRI when I was looking on the company website, you would be in the scanner from anywhere for 40, from 45 to 60 minutes for a head to toe study. When you get a normal targeted MRI of a specific organ Yeah. You're in the scanner for 45 to 60 minutes. Yeah. So you're getting a much higher resolution and better image of that organ than you are when you're roughly going down through the whole thing. And I'm not a radiologist, I do not claim to know all the nuances of radiology technology and reading but as I understand it, it matters a lot. What kind of study, what strength of magnet, whether or not you use contrast, what area you're focusing on, that is all very important to the quality of your image and the diagnostic usefulness of that image for a radiologist versus if you're getting a quick scan head to toe in the same amount of time, it's just not gonna be the same resolution or quality. Exactly.

Sonia Singh MD

Does the whole body MRI include contrast? Do they give contrast?

Rebecca Berens MD

So I actually couldn't tell directly from, but I think no, from what I could see, it did not appear to

Sonia Singh MD

interesting. I had one patient try to get one of these and the company contacted me asking for additional medical information and I was wondering if that was in part. To customize the scan in some way, but I don't know the answer of whether they actually did that or not.

Rebecca Berens MD

Yeah, so what I saw was that they do collect some health information upfront for the purpose of giving that information to the radiologist. Radiologists always love that clinical correlation. That's the joke in the medical world if you're not a medical person. But for the radiologist, I think they would maybe if there were symptoms or history, maybe look more closely at a given area of the body if there was some reason historically that might be of more concern. But as far as I could tell, it did not appear that contrast was given, which again, in some conditions makes a big difference.

Sonia Singh MD

Right.

Rebecca Berens MD

If you don't have contrast. All that to say, the company itself does not claim that they actually can do everything that I think is. Loosely sold. And and there's quality concerns with the image in terms of usefulness for certain certain types of diagnoses.

Sonia Singh MD

Yeah.

Rebecca Berens MD

So then I wanted to talk a little bit about what you've alluded to earlier, how do we determine if a medical test is worth doing? How do we determine the benefit of a medical test? And so there's a few things that go into this. So one is what is the accuracy of that test? How sure can we be that the results of this test are accurate? And that goes into things like sensitivity, specificity, positive predictive value, negative predictive value. So if you're not medical, these terms may not mean a whole lot to you, but basically what it means is sensitivity is how likely is it to pick up. A condition if you do this test. And then how specific is it for that condition versus something else? Yeah, so that sensitivity and specificity, positive predictive value is if this test is positive, how likely is it that you actually have that thing? And if it's negative, how likely is it that you don't have that thing? And I think there, to a lay person, there's this idea that a test is either positive or negative, and that's it. Like it just is, right? But there is no test that is perfect. Every test has false positive, false negative. Every test can miss things. Every test can have a positive that didn't turn out to actually be true. And it's just the rates of those various sort of errors that matter when we're, and in the context of the clinical situation. So if you do a strep test on 10 people, none of whom are having a sore throat, some of'em might pop top, pop up positive, but is that a clinically relevant strep infection? Or are they a carrier of strep? There's a lot of of nuance that goes into deciding to use a test when it comes to accuracy.

Sonia Singh MD

I think the approach a lot of people have is just isn't more information always better? Like even if The test is not perfect, even though it doesn't pick up everything, even though it might not be able to distinguish one thing from another. Isn't it better to just have the info than to not have the info? And I, we'll probably get into that. Yeah. That's when we talk about the harms. But I'm just acknowledging that is one reaction that I think a lot of people would have to you talking about the sensitivity's not great and the specificity may not be great, but don't we just, isn't it better to have the info than not have the

Rebecca Berens MD

info? Yeah. So is it, so that's the next dimension of test is clinical benefit, like

Sonia Singh MD

Yeah.

Rebecca Berens MD

Is the, is this information useful? And so how do we determine if something is useful? It's useful if it would change our management of a condition. And if that change in management would affect the outcome of treating that condition and especially is there benefit over another test that it already exists? So if we're looking at a new test, which like, okay, we're gonna add, say you're gonna add whole body MRI to your annual screening regimen. What is the benefit of adding that compared to the other tests that you already do,

Sonia Singh MD

do,

Rebecca Berens MD

And maybe cheaper. And so that there's a lot of weighing that you have to do there of what is the benefit of this test? What does it add? And then I think the last aspect is like value both to the patient and to the system. And this goes beyond just the clinical benefit of it makes your, you, if you, if we kind find a cancer that is treated, it makes you live another month or it makes you live another five years, right? Like those are different, those are different outcomes. And if you spent that last month that you had on chemo and in the hospital all the time versus you spent it at home and then found out a week before you died that you had it, which one was better for your quality of life? There's a lot, there's a lot into that I think it's so hard to explain and to talk about.'cause like you said, it always sounds like more information is better, but. When we look at the outcomes and the benefit to the patient, it's always a weighing it's not just, okay, you lived two weeks longer, you lived two months longer. It's what was the quality of those last two months?

Sonia Singh MD

See, I think people's response to that would be like that's not up to you to decide. And it's

Rebecca Berens MD

not

Sonia Singh MD

like that's up to me and I maybe I just want the two weeks longer no matter what it's like, or I wanna feel like I did everything I could to live two weeks longer for my family. So I, again, I think there's this distrust and this feeling that the doctor is making a decision for you about what you value and what you might want, and that this is a way to bypass all of that and just to get the information yourself, yeah. I think that's what people would say. But anyway, we'll talk about. We will talk about even if you go that route, what would be the potential, risks and benefits.

Rebecca Berens MD

Yeah. Yeah. And I think then the last thing we're talking about, the value to both the patient and the system for the test is what is the experience of having the test? And how much does it cost you? Because these tests, these whole body MRIs are in the multiple thousands.

Sonia Singh MD

Yeah.

Rebecca Berens MD

And I think the idea is that you do it every year, because obviously you get one, one year, that doesn't mean that nothing would be there the next year. So I think the idea is that this is a recurrent screening thing that you add to your regimen. And so that becomes quite costly and I think, to your point, it is always up to the patient if they wanna pursue it or not, but I think it's just a conversation that needs to be had and really understanding the nuance of that before. Just oh yeah, this can find all these things. Sign me up. Sounds good. It's let's make sure we're understanding the nuance. So we'll get into all of that when we get into the risks and harms too. But I did wanna share a couple of studies that I found that were had examined the sensitivity specificity, positive predict, predictive value, negative predictive value, all those accuracy based things that I mentioned regarding a test. So this first one here is whole body MRI for preventive health screening. A systematic review of the literature. It's from 2019. And so this was a study that looked at multiple other studies reporting full body MRI findings in asymptomatic adults. So this is in the population that we are talking about without a known disease syndrome or a genetic mutation. So people that might, be getting this, who don't have a clinical reason why it would be ordered normally. So there's 12 studies over 5,000 subjects. And so the pooled prevalence, excuse me, of critical and indeterminate incidental findings was 32%. So quite a high percentage of something being found. Now, the difference how they defined critical versus indeterminate critical was like, meaning that it did require medical intervention that would change an outcome, whether mortality or morbidity, it would actually improve something for the patient to, to intervene versus indeterminate was it was a finding and it wasn't clear how much there was gonna be any effect of intervention or treatment for that finding.

Sonia Singh MD

Those things don't seem like they should be clumped together.

Rebecca Berens MD

Same so they do separate it out later, but Oh,

Sonia Singh MD

okay. Okay.

Rebecca Berens MD

But the point being like 32% something was found clump.

Sonia Singh MD

Okay. But honestly, I'm surprised that in, what is it? 60 8% of people, nothing was found. That's honestly shocking because I would, I feel like the vast majority of people, you're gonna see a little degenerative disease, you're gonna see a little Yeah. A little, some little cystic stuff here and there. Like I I'm impressed that there's so many people that are totally normal.

Rebecca Berens MD

So I don't think, I think I don't think this is including things like a little bit of fatty liver or a little bit of this is just a finding that was like what should we do about this? Finding? Not to say that there was definite benefit to having found this thing, but like it was indeterminate versus some of these things that are

Sonia Singh MD

term. All of those things seem like they could you could argue that any of those. Things that to me feel very incidental, are things that, okay, now you've identified potentially that could be clinically stupid. Yeah. You could try. I don't know. Anyway okay. Yeah. So 32% had some finding.

Rebecca Berens MD

Yeah.

Sonia Singh MD

Which to me I'm just like, ooh, ding ding. Lots of patients probably doing this scan feeling like, thank God I did this thing. Yes. Because look at these things Yes. That they found. Okay.

Rebecca Berens MD

And if you found an indeterminate thing, who can say if it made a difference To know that because now you know, you can't ever not know. So that's a separate discussion. Okay. The there was substantial between study heterogeneity, meaning like a lot of variation between studies, which is not surprising. Pulled prevalence of critical and indeterminate incidental findings together was significantly higher in studies that included cardiovascular and colon MRI versus studies that did not. So obviously the more things you're looking at, the more likely you are to find something. So pooled proportion of reported verified critical and indeterminate incidental findings was 12.6%. So 32% something was found. But verified findings, as in we did the follow up and we verified that was 12%. So that's a lot of people.

Sonia Singh MD

That's already a big jump. So like roughly half of those people who had something found initially when there was further investigation, that was actually not even a thing.

Rebecca Berens MD

Yeah.

Sonia Singh MD

Okay.

Rebecca Berens MD

Yeah.

Sonia Singh MD

Alright.

Rebecca Berens MD

Six studies reported, so specifically reported false PO positive, false positive findings yielding a pooled proportion of 16%. So these are things that again, going back to what Isha said about half of those people actually didn't have the finding when they went back to verify. But these are people who all then went and got other testing, additional

Sonia Singh MD

testing to,

Rebecca Berens MD

so they had this vis this initial thing, oh, this thing's found. Now you gotta go do some more testing, more cost, potentially harms associated with that. Verification, whatever that was. Was it a biopsy? Was it, who knows? Yes. Was it a study with contrast? So now you've been exposed to contrast that you weren't exposed to before. Lots of potential harms that could have happened just in the verification process. None of the included studies reported long-term verification of negative findings. So that was interesting to me too. So you didn't find anything. But did we follow up to see if anything had popped up in the next five years that maybe could have been found? We didn't have that data. Only one of the studies reported false negative findings and that was a proportion of 2%. So this is people who the study said there was nothing wrong, but there actually was something wrong. So that's false reassurance, right? You got a study, you got this test done and said oh, you're good. There's nothing here. But that was actually false reassurance'cause there actually was something there and that wasn't even reported by all of the studies.

Sonia Singh MD

And I'm assuming that they're talking about things that could have been potentially seen on imaging. Correct. But were not seen on imaging. Correct. As opposed to. High blood pressure or something like

Rebecca Berens MD

that. Yeah. Yeah. Of course. Okay. Because yeah, these are things that would've been,

Sonia Singh MD

yeah.

Rebecca Berens MD

Potentially seen. So yeah, so I thought this kind of reflected while what we've just talked about is you can have false positives, you can have false negatives, you can have findings that didn't change your life in any way, but now you've spent more time and money and brain space on them. So how useful was this exercise to you? And as you said, that is up, ultimately up to the patient to decide, but I think it's important to understand the limitations and these are some of the limitations.

Sonia Singh MD

Yeah, I'm actually not philosophically totally opposed to the idea that patients can make these value-based decisions about what additional care they want to get in the healthcare space. I think that's an inev, that is a thing like in, within. The healthcare system, like traditional healthcare, we do have a certain finite number of resources and we have payment systems that require us to be, to follow certain guidelines so that it keeps everybody honest ish, although it really doesn't do a good job of that. We, a lot of these insurance denials, the, as much as you and I hate them, it's like they're there to actually protect the patient from getting a bunch of unnecessary, like a doctor from ordering a bunch of unnecessary things for somebody that they don't need and that are not gonna

Rebecca Berens MD

It's to prevent the insurance coming from paying for a bunch of things.

Sonia Singh MD

Okay. Yes. And ultimately it's to prevent them from paying anybody any money. Yes. Just deny you care so that the patient doesn't ever get what they should be getting. But anyway yes. The guidelines are there for a reason, but if. If you're in a situation where you have unlimited resources and your values are different, and you are in consultation with a qualified healthcare professional, making a decision to get this test and then to review the results with them, and you are already under the care of that physician and you are doing all of the evidence-based recommended screenings already okay, I guess we can say in my mind I'm like, all right, this person is going in fully informed. Maybe this gives them additional peace of mind and that's worth the cost of it to them.

Rebecca Berens MD

Yeah.

Sonia Singh MD

The concern I have is just that I don't think these companies have any interest in giving people true informed consent. Yeah. Ultimately they're just, they're profit driven companies that have good marketing. And the good marketing is not gonna be like, and by the way, make sure you're also getting your mammogram. And make sure you also talk to your physician about whether you qualify for high risk lung cancer screening. And also be aware that. About 50% of the findings on this may actually be not true on upon further testing information. It's just, they're never gonna have that con, maybe there's something written in the contract that you sign when you sign up for these, beyond that fine print that you read. But I just don't know that people have that full understanding when they go into it. And I don't think, and this is the thing that, you and I see on the other side of this all the time, I think they don't have a lot of appreciation for an understanding for how it can spiral out of control very quickly. And how yes, the MRI doesn't have radiation. And yes, maybe they won't give you contrast, but then maybe they find something and then you are gonna do a CT with contrast and then, oh no, now we're not really sure what that thing is, so we're gonna check it every six months. And even though statistically the likelihood of that thing being anything significant or worrisome is really low. Now that you've seen it, there's like a cover your behind yeah. Component to medicine where then it's we saw this thing, if we ignore it and it becomes something bigger, it's on us. So like we're gonna keep re-imaging it every six months or every year or whatever until, so actually, you know what happened with my mom is like relevant here. So she went for her total body CT in India on as u per usual. And my mom has pain in all kinds of different places and, constantly worries that she has a lot of different conditions, but she did not have pain in her chest wall. And they saw a little lipoma in her chest wall. And she had never complained about it before. That was not of all the areas that bother her. That was not one. But after they had noted it, she just became so fixated on But are they sure it's a lipoma? What if it's not a lipoma? What if it's solid? What if first she was like, I don't know, the radiologists were in a different country. Maybe they're trained differently. Maybe we should have it redone here and see if they still see it and if they agree that it's benign. And so then I think she came home and had another scan. And then after she had that scan, I think she ultimately had a biopsy.'cause then she, I think maybe there was a little bit of disagreement on the two scans about what it was. And so then they were like we can put a needle in it if you're, uncomfortable. So then she got it. Biopsied. And then the, after the biopsy, she started having pain, which like maybe that was just scar tissue or something related to that intervention. And then ultimately, every time they tried to go in and do something else, she kept having more pain. So they were like, let's just stick size the thing. So then she had an excision, and then she had a complicate, she had a hematoma following the excision. So this is just a perfect example of how it seems like such a benign I'm just gonna get a scan, and it's okay, I'll I'll be cool about the results, and then. Like you said, once you see it, you can't unsee it. And it, it just spiraled into this whole other thing. And she still has a little bit of scar tissue in that area where she's just man, that thing never got better. And I'm like, you never should have got that whole body CT scan'cause we probably never would've seen this thing. But yeah, I just think for a lot of people it's hard to imagine that hypothetical of going down that route and ending up having to do all these things. And I think also people are so driven for by the desire to get the answer and find something that might be wrong, that they discount how much harm is done in the stress of that. Yeah. And every subsequent test that you do, every subsequent wait for the results, every next test, the time, the energy, the money, all of it. It's a, it's a big deal, you

Rebecca Berens MD

know? Yeah. Especially, if you think, okay, how many hours did she spend. Going to all of these various appointments. And if you are someone who is a working parent and has older parents to take care of, and you're like, oh, I'm, let me I need to be healthy for all my people around me. So I could see this exact scenario where you're like, there's so many people to depend on me. I need to make sure I'm okay. But now you've spent so many, so much of your time and energy and brain space following up on something that never was gonna affect your life. It's actually harmed your very reason for getting to study.

Sonia Singh MD

Yes. And the other thing I would think about is I feel like a lot of our follow-up guidelines for renal masses and pulmonary nodules and whatever, a lot of those were built probably on data of people who had the fun the thing found because they had some other scanning done. Yes. That was already a population that was sick or getting scans for something. So now I think if you apply all of those same, algorithms to people who just got these who were totally healthy and got these scans, just because, the pretest probability as we say in medicine, or the likelihood that there's actually something going on there for somebody who has no clinical symptoms and no, signs that they're ill in any way is low. So those might even just following the guidelines after you find something like that's incidental might not even be as helpful for you as we, we think it is,

Rebecca Berens MD

yeah. But as you said in our litigious practice environment, you are not gonna be the one to not follow the guidelines, right? You're not gonna say oh yeah, that's probably fine. Once you've seen it, you have to follow it all the way through. And if those are the only guidelines we have, that's the guidelines you're gonna follow. Even though they don't directly apply to that person, we have to be conservative. We can't. In the absence of evidence to the contrary, we have to just see it through.

Sonia Singh MD

Yeah. Contrary to what I think a lot of the zeitgeist tells us doctors don't really wanna miss stuff.

Rebecca Berens MD

No,

Sonia Singh MD

we don't want to miss something that turns into something bigger. Yeah, especially once you've seen it, even if you think the risk is so low that it's something significant, you are stuck following it and it, it does suck. I'm just amazed like the last few episodes, sometimes when you've shared these studies where I'm just they're doing these on so many people. How hard would it be to do like a better quality longer term follow up? If they really wanna prove to us we catch, we, we improve mortality for patients with early stage pancreatic cancer we detect more ov show me that,

Rebecca Berens MD

Yeah. Yeah. And that's the other thing is so there, there was a company sponsored study that I actually couldn't find the text for, but it was referenced. On one of the company's websites. And I couldn't find the text for it, so I didn't include it.'Cause I couldn't really read it. But but even that, it was all about what they find not about the outcomes. And I think that's the key. Yes. Difference is like when we are talking about a pap smear, getting a pap smear done is not fun. No one likes going to get a pap smear, but we have really good data that saves lives from cervical cancer, like really good. And getting this annoying regular. Invasive test is worth it. Because of the data we have on the outcomes differences. But it, but that's not true of a transvaginal ultrasound of an, of for ovarian cancer. We don't have that data.

Sonia Singh MD

Exactly.

Rebecca Berens MD

And that's, I think, where the difference is. And like that, and that's again, what I wanna see as well is it's not just did you find something, it's, did finding that thing make a positive influence in that person's life? Or did it more often make people's lives worse?'cause now they have more medical appointments to go to. So I think your story actually illustrated all of the risks that I was gonna discuss perfectly. The workup for the insulinoma and the accompanying risks of that work workup. Like you said, you end up with more scans, more radiation exposure, potentially a biopsy and complications of a biopsy. You end up with just the cost and time of doing all those things. There's also MRI specific risks. So if you have certain implants, you can't go in an MR MRI if you have certain types of metal. If you're claustrophobic, a large percentage of people. I found the practical guide to MRI imaging MRI safety claustrophobia in three to 7% of patients. A lot of patients who have to get an MRI done for a clinically appropriate reason, we actually have to give them some sort of pre-medication to be able to tolerate lying in this very small scanner for a long period of time. So it's not a pleasant test either. And then, if there're, you hear like those crazy stories of the some magnetic object that somehow makes its way into the MRI machine room and like flies across the room that could injure you. It's rare, but it could happen, right? It's a risky must consider. And then I think the biggest one for me though was one of the key things that advertise is the peace of mind, but this does not fully reassure you of anything. There are false negatives, there are conditions that cannot be evaluated with this study. So how much reassurance are you actually getting for the potential cost and the potential risks? And that's I think to me the biggest thing because if someone I can think of an example of some patients that I have who don't have insurance and insurance is very costly for them. They may be self-employed or they have, a really they had marketplace, but it was too expensive. Whatever it was, they've dropped insurance. And so now they're looking for how can I get the biggest bang for my medical buck?

Sonia Singh MD

Yes. Yeah.

Rebecca Berens MD

I could see that person saying, you know what? I can't afford to do all this stuff. I'm just gonna get this once a year. And now they've missed all of the true evidence-based screenings.

Sonia Singh MD

Yes.

Rebecca Berens MD

And replaced it with this thing that is not a true replacement. And they've spent a lot of money without getting a lot of value. And that's, I think the other sort of issue that I see is if this is something you wanna do, in addition, you have all the resources in the world and you understand the risk be my guest,

Sonia Singh MD

yeah.

Rebecca Berens MD

We can. Talk another time about the limited healthcare resources and how we should allocate them for our world. That's a whole other discussion. Yeah. And that we can't get into here, but in our current setting, you can get whatever you wanna pay for, right? And if that is what you wanna pay for, and you are fully aware of the risks and you have the autonomy to make that decision, as far as I'm concerned. That's fine. But to me it's just making sure that you truly do understand what it is that you're getting and what you're not getting. And I don't think that is very clearly communicated in the advertisements, at least that I've seen. And in the influencer's discussions of people who got their free scan,

Sonia Singh MD

I'm so amazed that they put metabolic conditions and autoimmune conditions on there.'cause those were Some of the things that immediately came to my mind of you could totally have uncontrolled hypertension, have nothing on these scans. You could have diabetes or pre-diabetes, have nothing on these scans. You can have thyroid disease and hyperthyroidism, nothing on these scans You can have. Multiple types of autoimmune disease that I can think of and have nothing on a scan.

Rebecca Berens MD

Yeah.

Sonia Singh MD

So I, this, and those are, over 50% of adults have high blood pressure. So these are some of the most common, high blood pressure and diabetes and prediabetes are some of the most common things we see in primary care. So if you are bypassing the normal doctor's appointment and doing this you're just, like you said, it's just a hugely false sense of security that you've done your due diligence. So I actually, I just, this ring a bell in my email when you were talking about that one study they always referenced.'cause when my patient did one of these scans, the rep got very clingy with me and was trying to convince me to look, oh nice. These, and so he actually sent me, it's not, of course it is not the actual paper. It is it, to me it looks like a, it's like a poster. It's a brief it's got

Rebecca Berens MD

oh yeah, that's, they had that on the website.

Sonia Singh MD

They have. Oh, you saw that? Okay.

Rebecca Berens MD

Yeah, I saw that.

Sonia Singh MD

They did have they. They have some information here. So like the study was in 2,600 patients, like pretty good pretty good size. The mean follow-up was 14 months. Oh actually nevermind. The total number that were actually included in the study were only a thousand.'cause they screened out some people who didn't wanna do the follow up and who didn't, who had active cancer at the time. Okay but this was healthy. This was like, as far as we know, healthy people. So the rate of cancer detection among those thousand was 2.1%. Positive biopsy rate is listed as 56%. I don't know if that means like the lesion that they saw was positive 56% of the time, but I don't know why they're calling it cancer if it was not positive. So I don't exactly know what that means. It's a 64% of the cancers were detected in an early stage. 36% were detected at late stage. Now let's look at what cancers they found, because that is really interesting data. The most common ones were prostate, which was three. Thyroid which was four, and breast, which was four, and then kidney was three. But even if you're just looking at prostate, thyroid, and breast, so first of all, breast cancer, you gotta wonder if some of these people had not had their recommended mammogram or breast MRI or all, like they had not had the evidence-based screen. Yeah. And who knows in how long. So those, and the fine print that you acknowledged, it says that it does not replace the, those screening tests and those are clearly superior for detection. Yeah. Breast cancers I. Thyroid cancers and prostate cancers. We know those grow really slow. Yeah. They're pregnant in a lot of people. I dunno the age ranges of this population. But if it was just an older population, those are, I don't know the prevalence rates off the top of my head, but if you just scan everybody's thyroid in prostate, you're gonna see a lot of those. You know the number 2.1%, it doesn't sound super impressive, but it's, it's a decent chunk of people. But then when you drill down and you look at, what were those cancers, a lot of those were probably cancers that were gonna be clinically insignificant for. They may never cause them any problems they made have died with those cancers present without ever having an issue from them. But

Rebecca Berens MD

now they might have had a traumatic surgery in their neck or prostate, thyroid damaging surrounding nerves,

Sonia Singh MD

thyroidectomy. Yeah. And they now they're incontinent and they've got all kinds of other quality of life issues. Yeah.

Yeah.

Sonia Singh MD

So

Rebecca Berens MD

Those are the cancers that are most commonly the ones you die with, not of, and yeah, I think that's the other thing that like you said, there's this idea of more information is better, but especially in those two cases, it's often not, because there's often cases where this is something that may never have affected you, but now you've gone and gotten a bunch of intervention for it. And like prostate and thyroid cancer treatment can be really devastating if there is a complication. And even without major complications, there can still be functional issues. You can have voice changes, you can have, like you said, incontinence, erectile dysfunction, a lot of issues that are quality of life problems from more aggressive treatment that was maybe necessary for those cancers.

Sonia Singh MD

Yeah. So I think it just. I think when you just look at the headlines, of that study, it may look like, oh, okay. There's like something there. But I don't know, when you drill down to me and you don't know who these people were and how much were these people? It says they're asymptomatic, but are these people who were in contact with the healthcare system before or not? Yeah, if they were not, if you take a population of people who are like, I haven't seen a doctor in 10 years you're gonna find some stuff, yeah. Because they just have not been interacting with anyone who might be doing appropriate, screening and exams and things. So I don't know. I, again, this company, and I think there's probably a few of them now, but it's so big and it's so popular. I can't imagine that they don't have opportunity to give us more data to prove their point if it exists. And i'm just tempted to believe that they don't even wanna try to do the full study or to do a high quality study because they know that the findings are not gonna be like that.

Rebecca Berens MD

Or they'll do it, but they'll do it after you've paid for it. You're paying to participate in their study. You, that's true. You're paying thousands of dollars and they'll report your data later and it may not show what you were hoping it showed, but you paid for the privilege. Versus if you're in a regular medical study, you get compensated for your time for doing the study. So

Sonia Singh MD

that's true. You're also paying to be their Guinea pig if they're,

Rebecca Berens MD

you are. You are. And and that's the thing again, it's if you are fully informed and that's what you wanna do, and that's not using those resources for, that is not harming you in any way, by all means, but I think for most people. That's probably not the case. Most people, I feel like, are not fully informed. There's not a full understanding of this because it's, the way it's presented is not exactly what is actually the case.

Sonia Singh MD

Yeah. I have participated in clinical trials before and there is a very long, boring humdrum process where they talk you through all the terrible things that

Rebecca Berens MD

could happen

Sonia Singh MD

to you, including death. And I just can't imagine, I'll ask my patient who's done the scan, I'm like, cannot imagine them sitting you down and really having a thorough informed consent conversation.

Rebecca Berens MD

Oh, I'm sure. It's some sort of document you scroll through and like e-sign button when you book the appointment,

Sonia Singh MD

you're right. Okay. All right. Let's go back to our where are we in our,

Rebecca Berens MD

I think we're at, what can we learn from this as doctors and humans?

Sonia Singh MD

Okay.

Rebecca Berens MD

So what,

Sonia Singh MD

what would you

Rebecca Berens MD

say, what can we learn? I think what we learn is people wanna be a proactive about their health. Especially now there's a lot of health anxiety and we, and they strongly desire more information. They wanna, it clearly explained. And I think another thing that's, I saw the report that my patient got from their study and it was a beautiful, very long

Sonia Singh MD

Yeah.

Rebecca Berens MD

Very detailed report. It gives a lot of information so it feels very complete, which is not what people get when they go for a regular screening. Yes.

Sonia Singh MD

Yes.

Rebecca Berens MD

And it's written in very clear lay person language versus when you get your, mammogram result pop up on your portal and it's all bio blah, blah, and you're like, what does this mean?

Sonia Singh MD

Rad too? What does that mean?

Rebecca Berens MD

Yeah. And I think there's this clear gap in the way that we're currently doing things that people want to be filled. Like I want information and I want you to explain it to me and I wanna feel reassured. Yeah. And we're clearly failing at that. Yeah.'cause people are turning to these other options. And I think it, it comes down to our, innate fear of uncertainty. And the sort of hidden threats that we wanna try to protect ourselves from that can make this sort of marketing very effective. And I think, as doctors, our role really needs to be to make sure that we are giving people a full picture and helping them come to an informed decision. Because again, I don't think either one of us at the end of this is you're an idiot if you do this. You're not if you choose to do this and you understand the risk, I think that's perfectly reasonable. But I think it's making sure that it's an informed decision is the most important thing for me. So I think that's something that, that I'm taking away from it. And I think now that I've done this deep dive, I feel it wasn't anything that I wasn't expecting. I was like, I think this is what I'm gonna find and it is what I found, but I feel more prepared to talk about it. With patients and give them actual data and and answer their questions about it.

Sonia Singh MD

Yeah, I think my biggest takeaway from this is maybe when I talk to people about this, a lot of times they'll ask me would you have it? Would you get it? And I always tell them, I'm like, the fact that I, with my medical knowledge and I have the resources to go get it, but I'm not, that should say something to you.

Rebecca Berens MD

Yeah.

Sonia Singh MD

But I think a point that I would, I wanna make a better. Effort to bring home is just look, I respect your autonomy and like your values may be different than my values. Yeah. Your priorities may be different than my prior. Your resources may be different than my resources. And so this decision is up to you, but it's just my job, like you said, to make sure that you're fully aware of all of the risks and benefits and the limitations of this particular scan and how it fits in with all of the other things that we're doing for you in terms of your health. And I think just validating at the set the outset, like we did at the beginning of the episode, that it's so it's so natural to want, to do an additional screening or to do something else. And like the thought, I get scared by the thought of ovarian cancers and pancreatic cancer popping up in my patients, under my nose. That terrifies me, it, again, that doesn't mean we scan everybody head to toe or we just scan everyone's pancreas and ovaries. We have to be thoughtful and intentional about how we go about. Dealing with that. The other last point that you brought up that I'm like, we could just do such a better job of that in healthcare is to me it's almost become a red flag. How beautiful and color coded a results sheet is where like sometimes I'll get these microbiome reports and I'm like, this is beautiful, but doesn't,

Rebecca Berens MD

me meaningless, but very crazy.

Sonia Singh MD

Wouldn't say anything, looks very nice and looks, it looks very helpful. I don't know why we can't just do a better job of that in traditional medicine, like you said, even with a mammogram, would it kill us to have a paragraph that's just this is what this means. The percentage of women, put a few stats in there that give people a sense of okay. What benefit did I get out of this test? Or even just, and now with AI and so much auto, there's so many automation tools out there. I don't even think this would be that time consuming to create systems that

Rebecca Berens MD

Yeah.

Sonia Singh MD

Give lay language, and nice interpretation of results that translate like all of our medical jargon for people. That doesn't seem like it's that hard to

do.

Rebecca Berens MD

Yeah. But we just, because the number of patients that have called me freaking out after they get an indeterminate mammogram. And it's oh my gosh, I have breast cancer. I'm like, no, this happens all the time.

Sonia Singh MD

Yes.

Rebecca Berens MD

Get the follow-up imaging. We do not worry about it until we get the follow-up imaging. This happens so frequently, and I'm like, if there was like a, like you said, the colors like green, orange, red.

Sonia Singh MD

Yes.

Rebecca Berens MD

Orange is don't freak out, but go get the other imaging green is you're good. Come back next year.

Sonia Singh MD

Yeah.

Rebecca Berens MD

Red is okay, it's time to panic. I think it there's so much queuing that we could do that would be more patient friendly and would make people feel more at ease and I understand what's happening. Versus now it's this sounds really scary. There's an asymmetry. What does that mean?

Sonia Singh MD

Yes.

Rebecca Berens MD

It's yeah, we could definitely do a better job of that. And I think yeah, I think that's something that, you and I probably in our setting when we're talking with patients about results, we are able to spend more time and getting into it. And so I feel like we probably don't run into this as much, but in a big system where you're very busy and you have these auto sending of results in portals. There should be a better way. And like you said, maybe this is a good use of ai. I've yet to be happy with ai, but this one could maybe be one. That,

Sonia Singh MD

that's for another episode.

Rebecca Berens MD

Yes. But yeah

Sonia Singh MD

okay. Where can people go for more info?

Rebecca Berens MD

So I'm, I put the US Presentative Preventative Services Task Force website here.'cause I think it actually does do a decent job of a, b, c recommendations of how much data there is behind different recommendations for screenings. But I think the ultimate thing is this is an individualized discussion. And like you said, you need to understand what your personal risk factors are. So call your doctor, go for your physical and talk to'em about the screening stuff and figure out if there's things that you are due for that you, that are evidence-based that you should get. And then if additional screenings are things that you're interested in. Hopefully we answered a lot of questions about this one today, but you can have further discussion with your doctor about it.

Sonia Singh MD

Yeah.

Rebecca Berens MD

And make sure that they're not getting free scans from a full body MRI company if they recommend one to you, because that's a red flag.

Sonia Singh MD

That's a good point. Yeah. When I looked in my email for that study the email, the title of the email was like, partnership opportunity. So partnership, I feel like doctors already get a lot of a bad rap for are they profiting from doing this colonoscopy or this, these tests or prescribing that pill, and I think you have to scrutinize these companies just as vigorously. Yeah. Because if you follow, I agree with following the money, but if you follow the money you're gonna find some.

Rebecca Berens MD

Yeah. And it, it is hard to be fully objective about something that you received for free. Yeah. Versus. That was a gift to you from a company, right? Versus if you're the person that went and pulled out your credit card and paid several thousand dollars, it's a very different experience.

Sonia Singh MD

Yes. Yeah.

Rebecca Berens MD

Yeah.

Sonia Singh MD

The risk benefit equation has totally shifted, so

Rebecca Berens MD

yeah. Yeah. Okay. All right. This was a great episode. Thank you so much,

Sonia Singh MD

Rebecca.

Rebecca Berens MD

Yeah. Thanks.

Sonia Singh MD

Okay. Bye.

Rebecca Berens MD

Bye. Bye.

Sonia Singh MD

Hey guys. Last but not least, we have a very important disclaimer. This podcast is intended for educational and entertainment purposes only. The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation, diagnosis, or treatment. Listening to this podcast does not establish a physician patient relationship between you and the hosts. We are doctors, but not your doctors. Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances. Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health, medical conditions, or treatment options. Never disregard or delay medical advice because of something you've heard on this podcast. While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date. Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions. Medicine is not static and information may change over time. We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors Podcast, you have agreed to these terms. Thanks again for joining us.