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Why can't doctors order X-rays correctly - Pinner

Radiology Techs

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"We as technologists know the limitations to our scope of practice. Radiography Students, while learning, should be familiar with them as well because it can be very easy to cross the line if it is not well defined.

Patients (particularly those with no formal medical background of any kind) will not always be able to determine who in a hospital is a doctor, nurse, radiologic technologist, or lab technician. We are simply one more person in scrubs who has information about their health. In order to stay within our scope of practice and maintain excellent standards of patient care, we must know how to handle some difficult questions with tact. Here are 5 typical questions requiring some forethought:

What did you see on my x-rays?

This is probably the most common question, and it can also get you in the most trouble for answering. No matter how good you are at identifying fractures, dislocations, pneumothorax, or other types of pathology, it is illegal for you to give your opinion while remaining in your scope.

You can always inform patients of this fact. Some patients will say “I know that you know what you’re looking at” in an attempt to get you to budge, but are you willing to risk your license providing information that will be provided to the patient soon by their doctor? A good apology and encouragement that they will learn the results from their exam by the expert soon should satisfy their curiosity for the moment.

Inform them that their doctor should be the one discussing any results and a plan of care with them. Most reasonable people will understand. If they act frustrated, it is probably because it took them a long time to get the exam and they are expecting results soon, so don’t take it personally if they vent a little bit.

Why did the doctor order this exam?

In an ideal world, every single physician would explain the reason for every exam to every patient they refer for imaging procedures. Unfortunately, that is not the case. The prescription should state a reason for the exam ordered, and you can acquire some information based on a good patient history. Aside from those things, we as technologists don’t really know much about the physician’s reasoning.

We should, however, be willing to contact the ordering physician if the patient seems apprehensive about having a procedure without knowing why it was ordered. We should always refer the patient back to their doctor if after explaining the exam, they are not sure they want to proceed. Try to avoid talking them into a procedure or giving possible reasons for the exam when you do not know the facts. It is ultimately up to the patient if they want to continue.

Why won’t they let me eat or drink anything?

Sometimes outpatients have exams that require an NPO prep… these are easily explainable in that we need the stomach/intestines empty to allow our contrast to coat the lining.  It can also produce a false-positive exam if there is food mixing with contrast. Some ER patients need to be NPO for the same reasons, or if surgery may be required based on your imaging results.

It’s probably not a good idea to explain that they can’t eat because there’s a chance of surgery though. There are other reasons patients can be kept NPO such as lab work. In any case, it’s a good idea to instruct the patient to discuss the reasons with their nurse or ER doctor, and that you are following the directions of the physician.  It’s usually for a precautionary reason, but we aren’t doing anyone justice by guessing.

How much radiation am I getting with this x-ray?

Thanks to the Internet, social media, and Dr. Oz, there are many warnings about overexposure to radiation. It is true that we need to be conscious of our radiation dose and try to prevent unnecessary testing, but for some people, being informed means becoming a hypochondriac.

You obviously cannot simply tell a patient “you will receive about 10 mRads from this exam” and consider them informed and at ease about their exam. Most hospitals and outpatient imaging departments offer fliers explaining the risk vs. benefits for their exams.

There are even some websites that allow you to calculate your x-ray risk that can be referred to. We can inform them that we will take every effort to keep the dose as low as possible while using collimation and shielding, or we can even ask a Radiologist to explain the risk if they want more information about the dose itself.

If a patient wants to know about whether or not the test is necessary though, that should be a conversation between the patient and the ordering physician because we know very little about complete medical history and why the exam was ordered.

What will happen if I get this x-ray and I am pregnant?

We have a responsibility to explain that with any dose of radiation, no matter how small, some risk exists. That risk is increased when there is direct interaction with the x-rays and the fetus, especially in the first trimester, but it can be greatly reduced if the primary beam is far away from the fetus and appropriate radiation protection precautions are taken.

It also increases when a large number of exams are performed. A radiologist should always be consulted when we perform x-rays on a pregnant patient, and they can determine whether or not a limited procedure should be performed or the exam should be avoided altogether. Ideally, the radiologist would communicate risk to the patient. They might decide to contact the ordering doctor to learn more about the patient’s history first, and even recommend another imaging method if necessary. Our goal is to inform the patient while reassuring them that every safety precaution is being taken.

Our patients do not always understand our scope of practice. They might not understand the difference between a radiologic technologist and a radiologist. Patients even ask questions that are difficult for us to answer. We don’t have to have an exact answer prepared for each patient, but we should be able to either find them answers or point them in the right direction. We should be striving to keep them informed so they can be included in their health care decisions without providing false information or reason for alarm. A little tact will go a long way."

Source: Top 5 Difficult Questions from Patients, Topics in Radiology, September 28, 2012.


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