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.

The Fergussons

I've been spending my time searching for old photo albums. One of my finds was this picture taken in Canada in 1973. This image produced an explosion of memories about my grandparents.

My grandfather passed away in 1998 from complications due to lung cancer. He once told me that he had smoked since he was 16 and didn't stop until he was in his 70's. My grandmother was diagnosed with Alzheimer's Disease in the late 90's. She may have had it before 1999 but my grandfather kept it pretty well hidden from the rest of the family. Mind you, that generation learned to keep immediate family issues hush. When my grandfather died, we found out pretty fast about grandma's condition and placed her in an assisted care facility. It was when their house was being sold that my mom obtained personal belongings from my grandmother. This is the first time I've ever seen these albums. It's brought laughter and a lot of sadness to realize they are not here with us anymore.

One album in particular caught my attention. A simple trip to Canada in 1973. My grandfather was born in Albany Canada and later moved to the US. They meant everything to each other. Married in 1970 (my grandfather divorced from a previous marriage, and my grandmother a widow) they appeared to be inseparable. He was the only grandfather I knew. My own grandfather died a year before I was born, taken by leukemia in his late 40's.

My grandfather always spoke his mind with the usual catch phrase at the end, "are ya with me?" He may have seemed like he was annoyed by my lack of planning, but you knew he was telling you because he cared.

My grandmother was very simple, almost unaware of what's going on in the world. She definitely was from the "man takes care of everything" generation. With her big silver wig, sharp features and those cool Ray-Ban "cat eye" sunglasses (back in the 60's and early 70's), she was always dressed to the 9's for every occasion.

I have cousins, grandchildren from my grandfather's previous marriage. They all lived in Seattle, Washington at the time. When I was 12 or 13, my grandparents invited me to fly up and visit. I never grew up with any brothers or sisters so visiting my cousins was like the best thing ever. I loved being with my cousins, they were never thought of as step family. Some of my best vacation memories are with my cousins.

During the flight, I remember grandpa putting on the disposable earphones (you'd plug into your armrest and there was a dial to select preset stations), turning the station to his favorite Lawrence Welk music. Grandpa stuck his nose in the air, swaying back and forth in his seat while snapping his fingers to the beat. Of course I couldn't hear the music, but I could tell what he was listening to. I used to get stuck watching The Lawrence Welk Show whenever I'd spend the night at their house. I'd usually just lay on the floor and pet their golden labrador, Candy.

They had a place down in Corona Del Mar, a beach getaway. I'd spend the weekend with them every so often. Around 5:00 PM, we'd leave to go to a place called The Quiet Woman. Grandpa would joke around and say, "Okay Dave, let's go to the Headless Woman. Grandma would quickly correct grandpa and say, "The QUIET Woman Alec,...the QUIET Woman". I've shared that story with my own daughters and every once in awhile I'll take Pacific Coast Highway through Corona Del Mar on my way to Laguna Beach, and point out The Quiet Woman to everybody. Of course everybody in the car responds, "The Quiet Woman Alec, The Quiet Woman".

A favorite dish that was served on weekend visits at the beach house would be barbecued swordfish. It was sooooo good. In fact, after finding these pictures of my grandparents, I decided to extend grandpa's summer tradition of occasionally serving swordfish to my family and friends. I know I'll think of my grandparents every time I grill it up. I miss them very much. I miss grandpa's wisdom. There have been so many times I wanted to call him up and ask his opinion or advice regarding something. I miss watching him build things in his garage at the beach; clocks, airplanes, and other around the house repairs. At the time, you never picture life without them...are ya with me?