“I Just Want an X-ray”

(From 2021: Self Care is Good; Self Diagnosis isn't always)

People often want to order their own test. Or, rather, they call and want us to order the test they think they need. I usually decline such requests. Not because I’m mean spirited or money hungry, but because I am a conscientious doctor.

I don’t make any more money by making the patient come in so I can examine them and be sure to order the right test for their symptoms. I’m on salary. But I know anatomy and physiology better than most patients, and I know which test is better for what.

The self-directed imaging request is not a one step process. Whether the test is positive or negative, there are usually followup questions that require medical advice, which takes time and creates liability.

A sprained ankle can be as disabling as a broken one. What (free) advice do I give a patient I didn’t examine?

I, personally, would hate to be asked by a malpractice lawyer why I settled for ordering a plain X-ray of Mr. Barnes severely bruised leg at his request, over the phone, when it was swollen and tender and he in fact turned out to have a deep vein thrombosis that caused his near-fatal pulmonary embolus.

The other day a nurse called and asked me to order a shoulder X-ray of her husband with shoulder pain. When I saw him in the office, he had an A-C separation, a condition better evaluated with X-rays of the acromioclavicular joint – sometimes both of them, carrying weights.

It is important to listen to our patients’ accounts of their symptoms and their fears and concerns about worst-case scenarios. Some people need more and earlier imaging than others: Their past medical history (of cancer, for example) or nuances in their symptoms can make all the difference in the world.

I believe in, and very much encourage, self care for common illnesses and injuries. But when medical tests are called for, a medical person needs to order them and interpret their significance.