Do you read your own films?

[specepic]

How many of you out there are reading your own films? The practice I'm joining reads their own x-rays. The hospital owns their in office DXR so they are collecting a reading fee but not the facility fee. I imagine the former>>latter. I am inclined to ask to have my plain films reviewed either by in house rads or a service. I'll be paid on billed RVU's after my gaurantee expires and I doubt relative to everything else i'm doing missing something on XR is worth the $ to read it

Thx

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[axm397]

I read my own spine and hip films. I also rarely read my own extremity films but I dont' see that many of those because those go to the orthopods. I feel pretty comfortable going over the xray with the patients and if there's something suspicious or off, i get advanced imaging which is read by the radiologist.

I do have the option of sending to a radiologist so if there is reason for getting a radiologist read, I will.

 

[lobelsteve]

I read all of my spine MRI/Xray. I read all joint Xray.
I have a Radiologist 50 feet from my desk, so if I am concerned about something, or if the pics were not square on axials- I ask him.

I do not do official reports, just review the films with the patient. The Rad does the official report for medicolegal, billing. He is way better than I am at this.

 

[SSdoc33]

so i LOOK at all the films myself, but dont officially read them. i dont know what situation you have, but it sounds like your orthopods read the films, do an official report, and get paid for them without sending them to a radiologist as a means to generate a few extra $$$. that is fine, but be aware, that if you do this, and miss something (like a tumor for example), you will be liable. also, might want to check if your malpractice covers this.

 

[axm397]

the xrays are basically for initial screening. The orthopods mostly use it to look for fractures in acute care situations (i.e. athletic event - player falls, come to office, get stat xray). i get a lot of my patients from them (they keep the extremity patients and refer me the non-surgical spine) so a lot of the time the xrays are already done.(can do same day consult because not same specialty) because they don't get official reads, I end up looking at them and "reading" them and explaining to patient. by the time they get referred to me, they usually need an MRI anyway (already saw their PCP or saw one of the orthopods). I do have a radiologist one door away so I just hop in to see him if there's something odd.

Not sure if the group is billing for the interpretation - i'll look into that. (just started with the group 3 months ago so still not savvy about the billing/coding stuff) i'm not dictating an official read of the xrays although i do comment that we went over imaging together so not sure how that is coded. i just check off the visit level and the xray techs check off if any imaging was done.

 

[Jcm800]

so i LOOK at all the films myself, but dont officially read them. i dont know what situation you have, but it sounds like your orthopods read the films, do an official report, and get paid for them without sending them to a radiologist as a means to generate a few extra $$$. that is fine, but be aware, that if you do this, and miss something (like a tumor for example), you will be liable. also, might want to check if your malpractice covers this.

ditto, look at films and review them with patients. Call the radiologists to point out what they have missed. But i dare not "officially" read them for legal reasons...

 

[PMR 4 MSK]

We read and interpret our own films in office - bill global fee on them. No rad reads them. If I have a question, there's always an orthopod around.

We send our MRI's out, usually get report within a day, can do stat. But for spine, I'll often see the pt right after the MRI and give them my interpretation and initiate a plan. If the rad reads anything different I'll let them know. For all other MRI - hip, shoulder, etc, I wait for the report. I can't read them at all.

 

[Jcm800]

For all other MRI - hip, shoulder, etc, I wait for the report. I can't read them at all.[/QUOTE]

Me neither!

 

[Tenesma]

while most of us "read" our patient's films... i think it would be foolish to be the person legally reading it without radiology training.... while I do catch quite a few things missed by rads, at least i am legally somewhat buffered... whereas, if i am the one who misses the adrenal tumor on axial MRI, if I am the one who misses an abnormal density in a rib for L-spine xray, then i am screwed... if you are providing, billing for a radiologic reading, then you will be held to the standards of a radiologist...

why assume that extra risk??? an L-spine pays like 28$ is it really worth the time, dictation, effort, and risk???

now on the other hand, i know a group of orthopods who get the INITIAL films read by a good radiologist - and then all subsequent films (they get films pretty much at every follow-up) are read by them - they are making (likely accurate) assumption that the initial film will be screened for weird stuff..

 

[Mister Mxyzptlk]

It's frightening how many radiologists can't read a spine MRI. I don't do the formal reads but I always look at the films personally - usually with the patient during a visit. It really helps them understand what's going on. I give them a quick overview of what we're looking at, what it should look like, and what theirs looks like in comparison. They find it very helpful.

 

[ampaphb]

It's frightening how many radiologists can't read a spine MRI. I don't do the formal reads but I always look at the films personally - usually with the patient during a visit. It really helps them understand what's going on. I give them a quick overview of what we're looking at, what it should look like, and what theirs looks like in comparison. They find it very helpful.

you must have MUCH smarter patients than I do.

I go over lumbar and cervical MRIs with my patients as well, but am am largely (~60-75% of the time) met with blank stares, even when dumbing things down to a 3rd grade level (ie. the jelly leaked out of the doughnut). I find plastic spine models far more instructive in my population.

 

[Mister Mxyzptlk]

Nah, they just have a smarter doctor.

Good to have you back Peter.

 

[Tenesma]

even though 90% of patients don't grasp the MRI imaging despite dumbing it down quite a bit ---- they all say "You are the FIRST doctor to actually show me the pictures and show me my problems" --- they equate this show-and-tell session with superior care... i am not going to dissuade them of that notion

 

[Mister Mxyzptlk]

I had a patient badmouth me to another patient recently because I did an injection in her spine without getting any xrays first. I guess xrays are the pain doctor equivalent of FPs giving antibiotics for viral URI's.

Ordering imaging = good doctor

Going over the imaging with the patient = really good doctor

Even if the imaging wasn't necessary to begin with.

 

[Tenesma]

"Ordering imaging = good doctor

Going over the imaging with the patient = really good doctor"

Telling the patient that their pain is coming from "bulging discs" = Superstar Doc

 

[PMR 4 MSK]

"Ordering imaging = good doctor

Going over the imaging with the patient = really good doctor"

Telling the patient that their pain is coming from "bulging discs" = Superstar Doc

"No ma'am you don't have fibromyalgia. You have bulging discs and pinched nerves. We'll start a series-of-three epidurals today."

And yeah, I've had the patients get upset with me for not ordering an X-ray on their back, even though I ordered an MRI instead.

I think x-rays and MRIs are somewhat therapeutic. 😀

 

[Jcm800]

Bulging discs...

oi vey. I cant tell you how many times a day i get an MRI report with "bulging disc" circled and underlined and notes like "refer to NSG for possible discectomy" and when you look at the images it is a "mil broad based disc bulge"

funny how the patient always forgets the word MILD or MINIMAL in front of the the whole "bulging disc" thing

 

[mdvol]

My favorite is when I ask a patient to tell me, indicate, point to where they hurt and the first words out of their mouth is "I have a bulging disc at L4" and this is followed by "see, I had this car wreck when i was 16 and wonder if that has anything to do with.."

 

[Tenesma]

how about when they point to a painful lipoma and state that is their bulging disc...