Always good to rule out the nasties such as fracture, cancer, TB and Cauda Equina. Red flags are of course key, I admitted a patient only recently who presented with saddle anaesthesia.
Interestingly our local spinal clinic does the decision making over the phone !
I take your point about the MRI Radgirl, I guess I'm coming from a different perspective, if I sent every patient who attends with back pain, (about 3-5 a day), then I'd probably flood the system. And even if the scan was negative, when would I then re-refer ? If they were in pain still in a month, a year etc. I'm not sure that the results always correlate to the symptoms.
I'm wondering if the German experience is more to do with work ethic rather than intervention ?
Guess the worse thing we could do is send them for a traditional x-ray :-) Can't remember the statistics exactly, but isn't a lumbar x-ray equivalent to about 80 chest x-rays ? And medical radiology (UK) sparks off about 200 cancers a year.