We really need an X-ray? Pt. 1

An X-ray is one of the most common examinations in orthopedics. It’s so useful to see joint alignment and bone deformities quickly. However, at least in Japan, a lot of orthopedists take it without deep thought in some situations in which an X-ray is apparently unnecessary.
We really need X-ray every time we see orthopedists?

An X-ray is important but not NECESSARY

An X-ray examination is definitely important in some special situations, fractures, osteoarthritis etc. Other than that, we need to judge its necessity with enough consideration.

There are more important things before taking an X-ray

Have you ever experienced the situation described below before?

Doctor “How can I help you?”
You “I’ve been feeling back pain and stiffness.”
Doctor “When did it start?”
You “It started three days ago when I lifted a heavy stuff”
You “I see. Well, I’m taking an X-ray of your back.”

This is a quite common conversation in Japanese examination room.
However, as you noticed, there are two big problems.

1. The doctor didn’t ask you enough about your current condition and medical history
A medical consultation could help doctors, even orthopedic SURGEONS, to narrow down the possibility of patients’ conditions. This is just a rough estimation based on my own experience, but I believe we can diagnose nearly 30-40% of orthopedic diseases with enough medical consultation. In addition, information such as job, sports activities, daily steps etc, is highly important for us, orthopedists.
Medical consultation also has important role in communication. When patients visit a clinic/hospital for the first time, they generally are so nervous. The first conversation works as an icebreaker and helps us to create a reliability.

2. No physical examination before an image investigation
Not to mention, physical exam is necessary.
Patients do not always find their tenderness point correctly and the careful exploration tells us a lot of information.
Besides, some disease especially nerve-related ones cause a pain just with a specific posture.

TO BE CONTINUED.