MRI Scan - what next?
Discussion
Chaps,
Story here: I fell over playing squash in the summer, and damaged my shoulder. Right hand side (I'm right handed), and I felt it 'click' as I hit the floor, arm outstretched upwards, nothing to break the fall. It hurt. A lot.
I visit A&E (UCH) about 36 hours later. XRay shows 'nothing major amiss, although everything looks 'less tight than it should be.' Advised to see GP if it's not OK within a couple of weeks.
2 weeks later I go to GP, who refers me to physio. Physio is excellent, asks what happened, mauls me around, gives me exercises, tells me to come back in 2 weeks. This happens several times.
A month ago, physio said that it's not behaving as he expects, and sends me back to GP suggesting I should be MRI scanned.
GP refers me to MRI at Guys. MRI person says that results will be with GP within a week. I book an appointment to go back to GP a week later.
That appointment was yesterday. GP (different one each time - it is impossible to get a series of appointments with the same doctor at my local surgery) seems distinctly vague on the details and doesn't have the results from the MRI scan. He has (on the system) a letter from the radiologist, saying there is a tear to one of the tendons, but claims this is 'inconclusive'. He seems to suggest that I should leave it at that, but given the lack of movement and significant pain I am still in, I make it quite clear that I won't be doing so. He (reluctantly) says he will 'refer me to an expert', and then seems to be very unclear as to what the referral process is. He talks of a 'Choose and Book' letter but doesn't seem to know how or when I should get one of these. He says I can choose which hospital I go to but was pushing me (hard) to agree to go to The Royal London Hospital. I'd prefer UCH; I am told the medicine there is better and given the horror stories I have heard from the Royal London I think I'd prefer to keep clear. I suggest that UCH would be my preferred option, but he tells me this isn't possible (contradicting what he said 5 seconds earlier.) When pushed, it 'may be possible'. When asked what options I have, the only one he seemed certain about was The Royal London.
I'm happy to write off the GP as being poor, and complain appropriately. However, I'd appreciate some input from medical types on PH as to what the process is, or should be. Specifically;
1. Do I (will I) have a choice of hospital to go to or will I have to go to The Royal London?
2. What results would I expect from an MRI scan? Or - more accurately - should I expect more than simply a latter from the MRI radiologist? I was told by the doctor that referred me for the MRI that the radiologist would send a CD of the results to the medical practice, but the latest doctor said that CD's are never sent. Am I wrong in thinking that if the only outcome from an MRI is a short letter from the radiologist to the doctor then there is not much information changing hands and any form of diagnosis will be made on distinctly shaky ground?
3. What sort of "expert" is the GP likely to refer me to? I was so unimpressed with the GP I never actually asked.
All advice would be welcomed - thank you.
Oli.
Story here: I fell over playing squash in the summer, and damaged my shoulder. Right hand side (I'm right handed), and I felt it 'click' as I hit the floor, arm outstretched upwards, nothing to break the fall. It hurt. A lot.
I visit A&E (UCH) about 36 hours later. XRay shows 'nothing major amiss, although everything looks 'less tight than it should be.' Advised to see GP if it's not OK within a couple of weeks.
2 weeks later I go to GP, who refers me to physio. Physio is excellent, asks what happened, mauls me around, gives me exercises, tells me to come back in 2 weeks. This happens several times.
A month ago, physio said that it's not behaving as he expects, and sends me back to GP suggesting I should be MRI scanned.
GP refers me to MRI at Guys. MRI person says that results will be with GP within a week. I book an appointment to go back to GP a week later.
That appointment was yesterday. GP (different one each time - it is impossible to get a series of appointments with the same doctor at my local surgery) seems distinctly vague on the details and doesn't have the results from the MRI scan. He has (on the system) a letter from the radiologist, saying there is a tear to one of the tendons, but claims this is 'inconclusive'. He seems to suggest that I should leave it at that, but given the lack of movement and significant pain I am still in, I make it quite clear that I won't be doing so. He (reluctantly) says he will 'refer me to an expert', and then seems to be very unclear as to what the referral process is. He talks of a 'Choose and Book' letter but doesn't seem to know how or when I should get one of these. He says I can choose which hospital I go to but was pushing me (hard) to agree to go to The Royal London Hospital. I'd prefer UCH; I am told the medicine there is better and given the horror stories I have heard from the Royal London I think I'd prefer to keep clear. I suggest that UCH would be my preferred option, but he tells me this isn't possible (contradicting what he said 5 seconds earlier.) When pushed, it 'may be possible'. When asked what options I have, the only one he seemed certain about was The Royal London.
I'm happy to write off the GP as being poor, and complain appropriately. However, I'd appreciate some input from medical types on PH as to what the process is, or should be. Specifically;
1. Do I (will I) have a choice of hospital to go to or will I have to go to The Royal London?
2. What results would I expect from an MRI scan? Or - more accurately - should I expect more than simply a latter from the MRI radiologist? I was told by the doctor that referred me for the MRI that the radiologist would send a CD of the results to the medical practice, but the latest doctor said that CD's are never sent. Am I wrong in thinking that if the only outcome from an MRI is a short letter from the radiologist to the doctor then there is not much information changing hands and any form of diagnosis will be made on distinctly shaky ground?
3. What sort of "expert" is the GP likely to refer me to? I was so unimpressed with the GP I never actually asked.
All advice would be welcomed - thank you.
Oli.
I had an MRI recently due to a shoulder issue (all done privately under insurance). The consultant refered me to a place that did the MRI I then got a follow up with the consultant who read the Radiologist report and proceeded to load up the DVD and review it himself as well and gave me his interpretation.
I think in your case someone other than the radiologist should do the diagnosis after the scan.
I think in your case someone other than the radiologist should do the diagnosis after the scan.
The letter / written report from the radiologist is fine for the GP to refer you to an ortho specialist, sports injury surgeons, or musculo-skeletal. there is no point the gp having the MRI images. the specialist will want to see them though. if its at the same hosp they can view through their PACS system anyway. don't brush off the idea of going to another hospital because you may find that there are better specialities to be had elsewhere. do a bit of research re: sports injuries at the various local hospitals you may possibly be referred to.
For both my shoulder injuries, I just asked a GP to refer me to the hospital.
- 1 - consultation with orthopaedic surgeon who agreed something needed to be fixed, he put me on the waiting list for an op, went in for the op which consisted of exploratory keyhole surgery followed by surgery to fix it, referral to physio to strengthen it after it healed.
- 2 - consultation with orthopaedic surgeon who agreed something needed to be fixed, he put me on the waiting list for an op and referred me for MRI scans, now just waiting on a date for surgery (possibly keyhole, possibly full depending on what the MRI shows)
My experience of being offered 'Choose and Book'
I had a knee problem and my osteopath recommended an MRI scan. So appointment with doctor and referal to orthopaedic surgeon after a MRI scan- with the choice of 4 local hospitals and within 3 weeks. After seeing the surgeon he told me surgery would be between 1st Dec and 5th Jan appointment arrived 2 days later 5th Dec. Unfortunately he sadly passed away 8 days before I was due to go in(age55).His secretary phoned with new date 4th Dec with a different surgeon. So all this happenned within 3 and a half months, incidently it was one of our small private hospitals too.
So I was well pleased with the NHS.
I had a knee problem and my osteopath recommended an MRI scan. So appointment with doctor and referal to orthopaedic surgeon after a MRI scan- with the choice of 4 local hospitals and within 3 weeks. After seeing the surgeon he told me surgery would be between 1st Dec and 5th Jan appointment arrived 2 days later 5th Dec. Unfortunately he sadly passed away 8 days before I was due to go in(age55).His secretary phoned with new date 4th Dec with a different surgeon. So all this happenned within 3 and a half months, incidently it was one of our small private hospitals too.
So I was well pleased with the NHS.
Not sure where you are based but I know Mr Tennant at St George's in Tooting does some very good work. Website is: http://www.sgsu.co.uk/ (ignore the spelling mistakes 
)
)Chaps,
Interesting. Thanks for the answers.
Looks like I need to see what the doctor does in terms of Choose and Book, and to choose somewhere decent. I'm unclear as to how big an area will be opened up by this; the St Georges Shoulder Unit looks good (many thanks for the link Antonia), but it's on the other side of town and I don't know whether they will accept a referral from the East End.
Thanks for the input. It's appreciated. At the moment I'll be glad to have a stable shoulder that isn't (intermittently) very painful. My worst fear is that I will never get full movement and strength back in it, which will be a great loss (I'm aged 36 and active, hence this isn't a happy prospect.)
Oli.
Interesting. Thanks for the answers.
Looks like I need to see what the doctor does in terms of Choose and Book, and to choose somewhere decent. I'm unclear as to how big an area will be opened up by this; the St Georges Shoulder Unit looks good (many thanks for the link Antonia), but it's on the other side of town and I don't know whether they will accept a referral from the East End.
Thanks for the input. It's appreciated. At the moment I'll be glad to have a stable shoulder that isn't (intermittently) very painful. My worst fear is that I will never get full movement and strength back in it, which will be a great loss (I'm aged 36 and active, hence this isn't a happy prospect.)
Oli.
ukwill said:
shed driver said:
you need to ask your GP to refer you to an orthopeadic surgeon with a special interest in shoulders / upper limb injuries.
SD
This. The only thing I ever use my GP for is to get a referral.SD
FWIW it sounds as though you may have done some damage to your AC ligament. This can heal on its own but in acute cases may need operation, which with modern techniques, can be pretty straighforward and robust. The humungous tackle that the Welsh RFU skipper, Sam Warburton made was done with a shoulder previously operated on to have a Surgilig fitted.
Good luck.
Digga said:
FWIW it sounds as though you may have done some damage to your AC ligament. This can heal on its own but in acute cases may need operation, which with modern techniques, can be pretty straighforward and robust. The humungous tackle that the Welsh RFU skipper, Sam Warburton made was done with a shoulder previously operated on to have a Surgilig fitted.
Good luck.
Thanks Digga. From your comments it sounds like you are more commonly on the other side of the desk in the consulting room, so to speak. I can't remember the name of the tendon that I am told there is damage to ('spinatel'-something) but the physio wanted to know about the condition of the labrum as well, which apparently wasn't mentioned on the radiographers' letter. Good luck.
I am hoping that the Choose and Book letter will materialise this week. Fingers crossed.
Thanks again for your input, chaps. I know it sounds daft, but while I have a number of good friends who are medics I'm reluctant to discuss it with them; I guess I see health matters as being private and feel uncomfortable raising it with them. PH (with it's anonymity) provides the perfect forum!
Oli.
zcacogp said:
Thanks Digga. From your comments it sounds like you are more commonly on the other side of the desk in the consulting room, so to speak. I can't remember the name of the tendon that I am told there is damage to ('spinatel'-something) but the physio wanted to know about the condition of the labrum as well, which apparently wasn't mentioned on the radiographers' letter.
I am hoping that the Choose and Book letter will materialise this week. Fingers crossed.
Thanks again for your input, chaps. I know it sounds daft, but while I have a number of good friends who are medics I'm reluctant to discuss it with them; I guess I see health matters as being private and feel uncomfortable raising it with them. PH (with it's anonymity) provides the perfect forum!
Oli.
I shall tell Owen that! I am hoping that the Choose and Book letter will materialise this week. Fingers crossed.
Thanks again for your input, chaps. I know it sounds daft, but while I have a number of good friends who are medics I'm reluctant to discuss it with them; I guess I see health matters as being private and feel uncomfortable raising it with them. PH (with it's anonymity) provides the perfect forum!
Oli.
zcacogp said:
Thanks Digga. From your comments it sounds like you are more commonly on the other side of the desk in the consulting room...
Nope. I did not intent to mislead (before the BMC swoop on me for impersonating a doctor) in that respect. 
I am simply the sort of idiot/crash test dummy who has manged to acquire two, possibly three injuries on a shoulder, the final one in July requiring semi-emergency (never previosly heard this terminology) surgery. To wit:
Re: Choose and Book
What should happen - your GP should discuss all the available options with you and the pros and cons of where you can go for treatment. This INCLUDES private hospitals who offer treatment under PbR tariff.
Then you should have the option of book an appointment there and then with your GP on the Choose and Book system - you can see the name of the consultants in many cases, the times their clinics run and what 'slots' or appointments they have available.
If they aren't able to make the booking there and then, you will get a letter (normally right away, I'd not be particularly happy with the delay) which will give you your "UBRN" - a Unique Booking Reference Number and a Telephone number (TAL Telephone Appointments Line) to call. They'll do the above but over the phone.
If the GP was pushing for one particular Trust, I would report them to the local PCT. It is your legal right to chose where you go for NHS treatment, including out of area and private hospitals (OP, if you so wished you could have your treatment at a Spire hospital in Manchester, or Mid Staffs Foundation Trust )
Good luck. And don't forget it is your legal right to choose where to be treated as stated in the NHS Constitution.
What should happen - your GP should discuss all the available options with you and the pros and cons of where you can go for treatment. This INCLUDES private hospitals who offer treatment under PbR tariff.
Then you should have the option of book an appointment there and then with your GP on the Choose and Book system - you can see the name of the consultants in many cases, the times their clinics run and what 'slots' or appointments they have available.
If they aren't able to make the booking there and then, you will get a letter (normally right away, I'd not be particularly happy with the delay) which will give you your "UBRN" - a Unique Booking Reference Number and a Telephone number (TAL Telephone Appointments Line) to call. They'll do the above but over the phone.
If the GP was pushing for one particular Trust, I would report them to the local PCT. It is your legal right to chose where you go for NHS treatment, including out of area and private hospitals (OP, if you so wished you could have your treatment at a Spire hospital in Manchester, or Mid Staffs Foundation Trust
)Good luck. And don't forget it is your legal right to choose where to be treated as stated in the NHS Constitution.
AlfaPapa said:
Re: Choose and Book
What should happen - your GP should discuss all the available options with you and the pros and cons of where you can go for treatment. This INCLUDES private hospitals who offer treatment under PbR tariff.
Then you should have the option of book an appointment there and then with your GP on the Choose and Book system - you can see the name of the consultants in many cases, the times their clinics run and what 'slots' or appointments they have available.
If they aren't able to make the booking there and then, you will get a letter (normally right away, I'd not be particularly happy with the delay) which will give you your "UBRN" - a Unique Booking Reference Number and a Telephone number (TAL Telephone Appointments Line) to call. They'll do the above but over the phone.
If the GP was pushing for one particular Trust, I would report them to the local PCT. It is your legal right to chose where you go for NHS treatment, including out of area and private hospitals (OP, if you so wished you could have your treatment at a Spire hospital in Manchester, or Mid Staffs Foundation Trust )
Good luck. And don't forget it is your legal right to choose where to be treated as stated in the NHS Constitution.
Alfa Papa, What should happen - your GP should discuss all the available options with you and the pros and cons of where you can go for treatment. This INCLUDES private hospitals who offer treatment under PbR tariff.
Then you should have the option of book an appointment there and then with your GP on the Choose and Book system - you can see the name of the consultants in many cases, the times their clinics run and what 'slots' or appointments they have available.
If they aren't able to make the booking there and then, you will get a letter (normally right away, I'd not be particularly happy with the delay) which will give you your "UBRN" - a Unique Booking Reference Number and a Telephone number (TAL Telephone Appointments Line) to call. They'll do the above but over the phone.
If the GP was pushing for one particular Trust, I would report them to the local PCT. It is your legal right to chose where you go for NHS treatment, including out of area and private hospitals (OP, if you so wished you could have your treatment at a Spire hospital in Manchester, or Mid Staffs Foundation Trust
)Good luck. And don't forget it is your legal right to choose where to be treated as stated in the NHS Constitution.
Hmmm. That sounds really quite different to that which I experienced. In fact, totally different. As I said, the doctor I saw was a particularly crap one, and I think I need to distinguish between poor service from a poor doctor (which I am not that worried about), and a poorly-managed system (which I am rather more worried about.) For what it's worth, I had a telephone message from the GP practice yesterday saying that my CD was ready for me to collect. I was rather hoping that I would be getting a Choose and Book letter which wasn't mentioned in the telephone message. And I'm a little surprised to be being offered the CD, as it is of no use to me at all - I'd rather it was given to someone who can make good sense of it, and treat me accordingly ... !
Digga, that looks like an interesting shoulder. I'm not at all medical, but I think that even I can spot some hardware there that isn't quite as The Maker intended!
Oli.
zcacogp said:
Alfa Papa,
Hmmm. That sounds really quite different to that which I experienced
It may be that upon your collection of the CD, the GP may discuss this with you, with a view to referral. They ought to and mine certainly did. FWIW, NHS here in the UK did a sterling job of my aftercare (the orignal op was done in the Alps) and secoind op. Next op in six months...Hmmm. That sounds really quite different to that which I experienced
zcacogp said:
Digga, that looks like an interesting shoulder. I'm not at all medical, but I think that even I can spot some hardware there that isn't quite as The Maker intended!
Yes, I am now officially a mechanical animal, courtesey of an African doctor, working in the French NHS. Good job he did too (and at very short notice!) although the pins & guy wire solution to the ruptured AC ligament isn't commonly used over here - rather the Surgilig.N.B. Nurses on the French NHS seemed more abundant and younger than in the UK.
My mates did comment that every time they visited, there seemed to be at least two of them in the room. It wasn't all bad being stuck in hospital while the other guys were out on the mtb trails!Gassing Station | Health Matters | Top of Page | What's New | My Stuff