Saturday, August 22, 2009

Doctors Quick To Blame X-ray Techs, Again.

Okay, you knew it was coming. I've been sitting idle on this blog for quite some time. Now I'm finally moved to voice my opinion, a rant if you will. In the past few months I think I've let my Radiology followers down with guitar postings and more personal life reflections. So here it is.

I work in a facility that has an Urgent Care. For some reason, these doctors have complete confidence in their nursing staff to triage patients for x-rays. Double overlapping orders like "Right Finger" and "Right Hand", "Left Wrist" and "Left Hand". Basically really have no clue as to what will show the area of interest. We get orders all the time requesting "Shoulder, Elbow, Wrist, Hand". That translates to 3 images for the shoulder, 4 images for the elbow, 4 images to the wrist, and 3 images to the hand. That's a grand total of 14 shots of radiation to the body. Little do they know, they've just missed anything that might be broken in the humerus (between shoulder and elbow) and the forearm (between elbow and wrist). But don't ever bring that up because that might get thrown in there too if the ordering nurse is second guessing herself. We hardly ever get just a humerus and forearm ordered. This would show the entire humeral shaft, show a portion of the shoulder and two views of the elbow. Then the forearm order will overlap studies by providing views of the elbow while still visualizing the wrist and entire forearm. If anything, the ordering nurse should resort to this if he or she is doubtful as to what's visualized.

When x-raying a body part, there is a certain amount, criteria if you will, regarding the total area to be visualized. Outside of that perimeter may be considered as irresponsible use of radiation. The larger the beam, the more amount of radiation being used. Because of billing reasons, we are required to stay within the boundaries of which to image a body part. Outside of those boundaries are considered fraud, seeing more on an image than what's considered standard (translation if more than half of another body part is shown on an image then you took two exams for the price of one.)

Anyway, the point of all this information leads me to my next point. Doctors like to use words like "they" when describing something when things go wrong. When "they" is used when describing a wrong order, the patient interprets "they" as "x-ray", the people who took the pictures, never the idiot nurse who's not aware of anatomy. I performed a wrist exam on this elderly man a few days ago. I did the 4 required views and sent the patient back to the Urgent Care. About a half hour later, this patient returns with their wife for a forearm exam. I kindly mentioned, "oh, so you're back for more x-rays"? She replies, "the doctor said that you should have included more of the arm" and points to the middle of the forearm. Rather than go into a whole blame game with the patient, who really doesn't want to hear excuses but to just find out what's wrong and go home, I calmly mentioned that we are required to only x-ray so much and that it's not up to the x-ray tech to determine how much of an area, mentioned also about the exam is like a prescription, I can only do what's ordered. I'm fast so they were in and out quickly, all that really mattered to them anyhow.

But I can see how people can get things twisted around with a word like "they". I'm sure the provider said, "oh, they were supposed to get more above the wrist" could have implied that the nurse ordering the initial exam forgot to order a forearm with the wrist. Now you can see where the problem is.

The problem is that our Urgent Care nurses have been given the thumbs up to check patients in, ask them where it hurts, and then send them off to x-ray, BEFORE THEY HAVE BEEN SEEN BY THE DOCTOR! So we get lumbar spine orders when it's clearly a case of constipation. Orders for shoulder/elbow/hand x-rays for numbness and an hour later the patient returns with a Cervical spine order (don't get me started on the oblique orders for MVA patients). Or even better, an elbow and wrist order with comments stating, "show entire radius and ulna" only to call the doctor and be told, "I can't find the proper order, can't you just open the beam up and show me the whole forearm?" Yet time after time after time, WE the tech are portrayed as the idiot, the staff to point the blame to when something goes wrong. In some ways it's very similar to high school clicks, one group views they are the most important to the hospital. But let's face it providers would be BLIND without x-ray.

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