Why the President's "Routine" MRI Is Bad Medicine

President Trump recently received an MRI at Walter Reed Army Medical Center as part of what the White House called his "executive physical." His physician, Dr. Shawn Barbabella, reported the results were “perfectly normal.” But this sends exactly the wrong message to Americans about medical tests.

I won't question whether there were specific medical reasons for ordering the MRI — I'll accept the White House statement that this was just a part of routine screening. However, I will question whether there's ever a valid reason to order a "routine" preventive MRI for medical screening — a test that costs most of us about $3,000.

For the vast majority of people, screening MRIs provides little benefit and has the potential for real harm. That's why no expert group — including the prestigious US Preventive Services Task Force — recommends MRI screening in otherwise healthy people.

Surely detecting hidden abnormalities must be a good thing, right? The problem is that research shows screening MRIs don’t often detect important abnormalities. One study showed that 95% of healthy people who received a screening MRI had at least one abnormal finding. Almost all were harmless. These false positives include cysts, scar tissue, and variations of normal anatomy. But once detected, these unexpected findings trigger a cascade: more scans, specialist referrals, biopsies, even surgery. Each step carries its own risks, costs, and anxiety — all for no benefit.

Meanwhile, unnecessary MRIs tie up scanners, so people with evidence-based reasons for imaging face longer waits.

People come to the office requesting a test they believe is part of an “executive physical.” The concept of an “executive physical” is a marketing term, not a medical concept. Consider what happens when a 50-year-old business executive hears about the President's "routine" MRI and demands one from her or his doctor. The scan detects a small liver lesion. She then undergoes a follow-up CT scan with contrast dye, followed by a biopsy. Weeks of worry and thousands of dollars later, the results often confirm what was likely true from the beginning: she’s fine.

America is facing huge increases in health care costs at the government, insurance company, and individual levels. Many people get too little needed care — that's true. But I'm also concerned that others, particularly those with resources, are harmed by too much care through overdiagnosis and overtreatment.

Where is the shared decision-making where patients learn the real risks and benefits, then make choices aligned with their values?

There are certainly screening tests with proven value: mammograms for breast cancer, colonoscopies for colon cancer, blood pressure, and cholesterol checks. But not MRIs in people who are otherwise healthy.

When our leaders normalize unnecessary testing, they're not modeling good healthcare — they're modeling wasteful and potentially harmful medicine.

— Dr. Michael Wilkes with a Second Opinion

Further Reading:

• Choosing Wisely: A watershed moment in health care
• Imaging-Based Screening: Understanding the Controversies
• Too much medicine
• Income and Cancer Overdiagnosis — When Too Much Care Is Harmful
• The future of medicine lies in truly shared decision making