One of the unfortunate turns healthcare has taken is a deviation away from basic fundamentals. Despite the advances in technology, the reading of diagnostic imaging is one area that has suffered.
In the past, tests were ordered to confirm a diagnosis based on the patient's presenting symptoms, their history and objective findings. Other than in a hospital setting, imaging was quite often performed in the doctor's office and interpreted by the same provider who ordered the test.
The doctor knew what he was looking for or trying to rule out based on speaking with the patient and the examination.
Over time, and through the influence of insurance companies, most stand alone offices and clinics got rid of their xray equipment as many plans forced the patients to use a particular hospital or facility.
What resulted was radiologist reading films who had little to no information about the patient and relied on only what they see on a the imaging.
Previously, when an imaging prescription was issued, a detailed history was included in order to provide information to the person interpreting the studies. As I have seen and learned from radiologists, quite often this information is missing or sparse.
They may be looking at a neck xray and the only thing they are told is " neck pain" which doesn't tell them where it hurts, when it hurts or for how long they have been in pain.
They know nothing about the patient as far as their occupation, health history or overall physical condition.
Due to the lack of information, they issue a report to the ordering doctor which usually focuses on structural findings such as ruling out tumors, fractures or deformities.
While it is important to point these out, a great percentage of people presenting with conditions in which xrays are ordered are doing so because of biomechanical problems which may or may not show up along with structural concerns.
In fact, we are all taught the ABC'S of xray reading:
Alignment: How do the bones align with each other
Bone: Are there fractures, subluxations, dislocations, osteopenia, tumors, degeneration ect.
Cartilage: Are the joint spaces compromised
Soft Tissue: Is there selling or calcification of tissue?
I am seeing an alarming decrease in the frequency of adequate xray reports being issued from local area hospitals. Far too often, the reports downplay joint and disc degeneration as well as gross abnormal alignments.
The quality of reports I receive vary widely between not only the facility in which the xrays were taken but also by the radiologists reading them. I have read reports from Riddle hospital which were so detailed, I called the radiologist and thanked her but have also called complaining about key findings being overlooked or underreported.
This is why I always ask my patients to request a CD of their imaging. Many providers are part of a hospital network and can access imaging online but given the numerous groups in the area, not every provider has access to every network. I personally can view images online through the Crozer system but not Mainline Health or Christiana.
By having the CD, your doctor or any specialist you may see can view the images and, most importantly, show them to you and explain what is going on. Additionally, should something happen in the future, you will have an image of that body part and a report from which to refer.
Many people are turning to urgent care centers who may perform xrays there at the facility. If their issues require additional care, having the imaging in hand may reduce the need and cost of duplicative imaging.
There are many fantastic radiologists, techs and providers caring for patients in the area but the current state of healthcare has convoluted the process so much that I am concerned about the quality of care being provided at times.