Is It Any Wonder Many Physicians Think We Are Idiots?

[Guest HanSolo]

Ultrasound is the tech of the future. Lots of research and funding being poured into it right now. Quick, easy, cheap and no radiation. CT, MRI, etc. will only be used for special cases. Not sure when it will change but it is inevitable. Excited to see the new applications of it!

[GetMeOuttaThisMess]

"Don't use a test to make a diagnosis, instead obtain a test to confirm your clinical suspicion."  I respectfully disagree on obtaining spine films for back pain without a clinical suspicion for an etiology.  Having said this, OP, how many views are you obtaining?  During my spine days of the early/mid-80's (with Tiger Wood's alleged spinal surgeon and his other two original partners) when we saw chronic spine pain without a focal source (trauma, infection concern, scoliosis, neuralgia in a dermatomal distribution, suspicion for facet syndrome, and ankylosing spondylitis) we'd always get a 7 view panel to start.

[sas5814]

What is safer than low dose radiation? No radiation.

It is all balance and few things in medicine are absolutes. Never get an x-ray on a new complaint? Too broad. Always? Too broad. Either belief is incorrect. That is why we are professionals...to exercise judgement. If an x-ray was always appropriate the front desk could send them for an x-ray when they signed in.

[CAdamsPAC]

42 minutes ago, JMPA said:

This only reflects your limited understanding of x-ray application and interpretation. X-rays remain to be invaluable tools.

 

You're a myopic pissant "clinician" who by your answers confirms your inability to explain why you would order a radiological study. Prove me wrong and answer my simple question.

[Guest JMPA]

2 hours ago, sas5814 said:

"try explaining to a jury why you failed to do an x-ray (minimal radiation exposure) and missed lithesis, cancer, fracture ect."

 

It is interesting you lament our ability to stay on point with what you think the conversation should be about when you wandered afield first. This was not related to the subject at hand. You created a new conversation when you said this.

Lastly, and I have been away for a few days so I missed the bulk of this conversation, this was about a complete failure to even begin to do what should have been done for this patient and the neurosurgeon's (rightful) displeasure with this referral and how these kinds of things tend to reflect on all of us fairly or not. I think any of us who have been around for very long at all have heard plenty of  "those mid-levels" or "those PAs" as if we are all stamped out with a cookie cutter and have the same education, training, experience, and skill level.

look at the comments leading up to my first comment, they all have to do with imaging. The conversation changed from turf to imaging.  I only commented on the imaging aspect of the conversation because i disagree with failure to do imaging out of fear. When indicated imaging should not be delayed.

[Guest JMPA]

45 minutes ago, CAdamsPAC said:

 

You're a myopic pissant "clinician" who by your answers confirms your inability to explain why you would order a radiological study. Prove me wrong and answer my simple question.

when wrong resort to name calling, typical response of an ignorant person.

I always include my reason for imaging on my imaging request forms. If you do not know when and why to order imaging than you are an incompetent provider and should have your license removed.

[sas5814]

When indicated imaging should not be delayed.

I think you just nailed the point of the whole discussion. You started out implying..almost stating..that every patient who complains of back pain should have imaging. I have women with UTI symptoms who complain of low back pain as part of their symptomology. Xray? No...not without other compelling reasons. bend over and pull your back. Imaging? Not at the first visit in the absence of other symptoms or history that suggests otherwise. I am about to go see a 16 year old who woke with a bit of low back pain...nothing else...he is running around the clinic laughing and joking in no distress. Is he going to get an xray? Highly unlikely. He is just here because he has the best insurance in the world so he can.

The idea that imaging is low dose radiation so we should use it more just doesn't carry water. A test is either indicated or it isn't.

 

Send a patient to a neurosurgeon without any imaging or treatment in the absence of any compelling history or symptoms? Not me.

[lkth487]

On 9/25/2018 at 3:17 PM, JMPA said:

try explaining to a jury why you failed to do an x-ray (minimal radiation exposure) and missed lithesis, cancer, fracture ect.

This was your first post in the thread, responding to the scenario of a '1st patient of the day. Healthy 36 YO male with no history or co-morbidities sees an NP in FP with acute low back pain after handling some farm animals 10 days ago".  In this case, imaging is not really indicated in the absence of other concerning findings.  Everyone took you at face value in that you would order an Xray.  If you meant you would order imaging/emergent NSG consult if a 36 year old presented with loss of sensation and bladder incontinence, you should have mentioned that.  Or mentioned which scenarios you are talking about.  As others have shown, for routine lower back pain, imaging is not necessarily indicated.

 

On an exam, or in real life, if someone presents to you a scenario of "1st patient of the day. Healthy 36 YO male with no history or co-morbidities sees an NP in FP with acute low back pain after handling some farm animals 10 days ago", the correct answer might be "obtain a more thorough history", "do a complete physical examination", "reassurance and some nsaids".  The wrong answer would be "do a back xray".

Just admit you were either A) Wrong, or B) worded your reply poorly.  It happens.  We all do it.  It's fine.  Don't double down and then try to back out of it.

[CAdamsPAC]

On 9/29/2018 at 1:31 PM, JMPA said:

when wrong resort to name calling, typical response of an ignorant person.

I always include my reason for imaging on my imaging request forms. If you do not know when and why to order imaging than you are an incompetent provider and should have your license removed.

Not name calling but an apt description of your clinical skill set based on your post. Yet you continue to not answer a very simple and basic question. Deflection isn't an answer while attacking other's skills. Again prove me wrong with a coherent appropriate reply to my question or live with my description. BTW I'm Black so shouldn't I be calling you a racist too?

[karebear12892]

On 9/25/2018 at 3:17 PM, JMPA said:

try explaining to a jury why you failed to do an x-ray (minimal radiation exposure) and missed lithesis, cancer, fracture ect.

going back to your original post....

there's a reason why we instruct patients to RTC or f/u with PCP for worsening symptoms/failure to improve

[Guest ral]

This has been interesting reading.  Think I'll grab a beer.

[CAdamsPAC]

6 hours ago, lkth487 said:

This was your first post in the thread, responding to the scenario of a '1st patient of the day. Healthy 36 YO male with no history or co-morbidities sees an NP in FP with acute low back pain after handling some farm animals 10 days ago".  In this case, imaging is not really indicated in the absence of other concerning findings.  Everyone took you at face value in that you would order an Xray.  If you meant you would order imaging/emergent NSG consult if a 36 year old presented with loss of sensation and bladder incontinence, you should have mentioned that.  Or mentioned which scenarios you are talking about.  As others have shown, for routine lower back pain, imaging is not necessarily indicated.

 

On an exam, or in real life, if someone presents to you a scenario of "1st patient of the day. Healthy 36 YO male with no history or co-morbidities sees an NP in FP with acute low back pain after handling some farm animals 10 days ago", the correct answer might be "obtain a more thorough history", "do a complete physical examination", "reassurance and some nsaids".  The wrong answer would be "do a back xray".

Just admit you were either A) Wrong, or B) worded your reply poorly.  It happens.  We all do it.  It's fine.  Don't double down and then try to back out of it.

Falsus in uno, falsus in omnibus

[Guest JMPA]

On 9/29/2018 at 3:57 PM, karebear12892 said:

going back to your original post....

there's a reason why we instruct patients to RTC or f/u with PCP for worsening symptoms/failure to improve

there is a reason why somebody seeks medical attention

This is why MDs laugh at the newbie PAs and NPs, they dont understand the fundamentals of medicine

[EndBulbsOfMouse]

If you’ve never reassuranced and sent the patient home with anticipatory guidance and appropriate follow up, you’ve been practicing bad medicine.

That is part of fundamentals of medicine.  

[BirdDogPA]

11 minutes ago, JMPA said:

there is a reason why somebody seeks medical attention

This is why MDs laugh at the newbie PAs and NPs, they dont understand the fundamentals of medicine

With all due respect, there are plenty of MDs that have been practicing for years that don't understand the fundamentals of medicine. I don't think a degree or length of experience always equate to competence