The Hero vs The Fall Guy (Big X-ray Rant).

X-ray techs seem to be the fall guy when it comes to mistakes. It's aways X-ray's fault. When ever every upper level area of expertise messes up, it was always "X-ray". When we go up stairs to do a portable X-ray, we screw up the sheets, we mess with the I.V.'s, move the heart monitor leads around, and never put the bed back in the proper position. It's like how the jocks and cheerleaders view the drama department and band geeks (I am in no way saying that our doctors and nurses resemble jocks and cheerleaders, and hey!, drama and band is an important form of self expression!)

We are the most disrespected part of the whole medical community. It's true. There was a study made about 7 years ago that a fellow X-ray tech, now an ER Physician's Assistant who showed me a study regarding a survey asking all levels from top surgeon's, physician's, and nurses. Radiology Technologists were rated as the lowest respected in the field, lower than janitorial staff.

I find this interesting because if it weren't for x-ray, many diagnosis would never be discovered. Without X-ray, how would you know if you, a doctor, had placed a broken bone back to it's proper position (post reduction), a P.I.C.C line in it's proper place, making sure your hardware pins are going directly into the fractured bone for a hip pinning? Kidney stones, bone erosions, calcifications, bone malignancies, colon cancer, brain cancer, brain bleeds, subluxation of the cervical spine, scoliosis (degree of curvature), Calve Perthe's disease, displasia, growth plate fractures, radiculopathy, dislocations, foreign bodies, cardiomegaly, degree of severity of fractures (either trauma or pathological), pneumothorax, hemothorax, heel spurs vs plantar fasciitis, osteophytes, osteoma's, Osgood Schlatter's disease, nurse maid's elbow, osteoporosis, COPD, CHF, pleural effusion. I don't list pneumonia because I think some physicians can diagnose pneumonia without an x-ray. That's what the stethoscope is for, right? Or is that just the universal badge that says, "I'm a doctor"?

I'm not sure what reputations past X-ray techs have bestowed upon us but we are the filter for other people's mistakes. Today, I got an order for a wrist. Performed the x-ray and sent the patient back to the doctor. One hour later, the patient returns with another order. The Mom insists on coming into the exam room this time. She has been informed by the head UC physician that WE took the wrong views on the first visit. The new orders were for a hand x-ray. No matter how much I tried to convince the patient that I did exactly what was ordered, she accused me of trying to get out of my incompetent mistake because doctors don't make mistakes like that, only underachieving x-ray techs. Like I just sit here and pick whatever body part to x-ray.

To many people's surprise, x-ray orders are like prescriptions; you can only do what's ordered. All the time I get, "Hey, my shoulder hurts too. Could you take one of my shoulder also? CALL MY DOCTOR TO HAVE HIM ADD IT!" We have more than 50 doctors working in the building and sometimes they all send just one patient to us. When we have to stop and call to do one of these "add-ons", it puts the breaks on our operation, making all other patients checked in wait even longer.

I am bound by law to perform an x-ray to the exact request ordered by a physician. Only physician's order x-rays....sort of. The problem is, we have nurses that order the x-rays for the doctors before the doctor see the patient. So the nurse makes a guess as to what orders to make and promptly send them to x-ray. We get orders like hand & thumb, wrist & hand, foot & ankle, foot and toes. We cannot pick and choose which order best fits the patient's needs. If your pinky toe was injured and they order a full foot, then you're entire foot gets "nuked". So that's what happened today: nurse thought the wrist needed to be x-rayed, has no real knowledge of anatomy, doctor sees the patient finds out it's actually his entire metacarpals are the area of interest and sends them back to x-ray. The mistake? Physician makes the X-ray tech the idiot, because x-ray always messes up, right?

In my training as a tech, we went over countless anatomy training, pathology training, alternative methods of getting the most out of an exam even when you get a patient for an abdomen who's in the shape of a pretzel. When I received my Radiology license, I made a vow to do the best I can for the patient, always have the patient's best interest and to maintain the responsibility to uphold radiation safety by limiting the amount of radiation dose to every patient regardless of age. That is out the window when it comes to patients who demand X-rays for sore throats and blood blisters. Exams like an 85 year old woman for knee x-rays to rule out arthritis......You think? Geez, if you own a mirror and can read the birth date on your driver's license, then I'm betting you already know the answer to that.

Doctors don't have time these days to explain and educate misled patients regarding the necessity for x-rays. There are doctors that feel that ordering these exams help give the patients a peace of mind. Sometimes if a persistent patient asks for an x-ray, they'll get it, just to shut them up. It works. Even though that toothpick won't show up on an x-ray, or that Dorito that you swear is still stuck in your throat, or that cat bite that didn't even break the skin. Hello people, you just nuked yourself for no reason because those things don't show up on an x-ray!

X-ray techs must be known for lying a lot too. We have nothing better to do than make up some story in order to get out of doing our job. Regardless if an Urgent Care patient is going back to..well, Urgent Care, I always ask if the doctor is expecting them to return today. Most everybody says yes. But sometimes, some people use Urgent Care just to be seen that day when their primary doctor is not available. Occasionally, those people can leave after their x-ray is finished. They might be following up with their provider later or being referred to a specialist so it's not necessary to return to Urgent Care. I took an exam of a Urgent Care patient today, he told me that the doctor told him he did not need to return but had to go back for some other treatment. Ok, what reason do I not believe this patient? I send the patient back and then 3 hours later get a call from that patient's nurse saying, "where are the x-rays, the doctor is waiting to leave and he can't because he's waiting for us to deliver the films." I explained the situation and then I was blamed for the delay in the patient's treatment. Of course the patient never admitted to saying they didn't need to return with the films. So it was now MY responsibility to call and track down this film because this was all My mistake.

Ever since my back injury, I am to never return to portables and surgery exams. I miss surgery. I felt like an important key to the OR "Team". I was addressed by my first name, not just "X-ray!" They knew my work. I could intuitively know when and where they needed my flouroscopy "C-Arm". I developed this 6th sense, knowing when to run up to OR before they would even page me. I was fast, accurate, and I always helped out with assisting patients onto the surgical table. I felt respected. That was my arena. Everyone seemed to breathe out a sigh of relief when I'd be the one on duty (well, maybe not to that extent but I was told once how many surgeons were glad I was working with them on those surgery days).

One last good one; nurse forgets to place an order for an inpatient for an AM Chest x-ray, pages the portable tech to come up for a STAT exam (STAT by the way is supposed to be for life or death situations, not for right away because I've got to get to lunch). The nurse does this so that she does not get chewed out by the doctor. The doctor comes up to the patient's room to see the film, sees the x-ray tech taking the exam, yells at the tech for sitting on his butt all this time when the order was supposed to be done at 7:00 AM and it's now 10:30 AM. Nurse sits in her chair looking at the tech in the room, and not a word is said from the nurse. Anything the tech says at this point sounds like lame excuses in an attempt to get out of trouble. The x-ray fall guy, it's always our fault. Wouldn't that be cool to have a fall guy at your job to make you maintain your professional status? Find someone who can absorb all of everybody elses incompetence.

But it is funny, being the fall guy also means that you are perceived you have a breaking point as to telling the patient "did you see anything?" For being the fungal layer on the basement of the medical staff, we sure seem to be important enough to get badgered with that question. Nope, that's for the glory of the physician to tell you (and legally the only one who can tell you the results). After all, he's the most respected one in the medical community. The hero.

The people who tirelessly work, to strive, to obtain the best images possible, in the patient's favor, the ones who are trying to assist by x-raying patients in order to assist doctors better help patients, are the ones who are frowned upon the most. The fall guy.

(Disclaimer: In spite of my opinions I do respect many doctors at my facility. There are many great doctors that don't abuse their ordering privileges. These opinions are a generalization regarding radiology technologists as a whole. There's good and bad in every facility. Most of my opinions are based on the hospital poll and some personal experiences. I hope this does not offend the many doctors that I'm friends with who read this blog. I am not pointing a finger at any particular physician or patient care entity in particular.Order and patients from experiences have been changed drastically to adhere to confidentiality and to avoid acknowledging the location of my hospital and individuals involved.)