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How many times have you been asked, "Are you a Doctor?", or after a radiograph is taken a patient asks, "So is it broken?", or even when it's explicitly stated that you are not a physician, a patient says, "Come on, you've seen enough of these. Do I have cancer?". I'm sure the answer to the number of times you've heard these questions is anywhere from once to hundreds of thousands. A lot of times it's very tempting to answer these questions in order to prevent confrontation with a patient or to sound intelligent, however, regardless of the amount of times you have to repeat yourself and explain to the patient that you are unable to assist them in the diagnosis of their images, it's imperative that you are stern in your position.

The ARRT code of ethics states, "The radiologic technologist acts as an agent through observation and communication to obtain pertinent information for the physician to aid in the diagnosis and treatment of the patient and recognizes that interpretation and diagnosis are outside the scope of practice for the profession." Every technologist is aware of this statement. The code of ethics is drilled into your head from day one of x-ray school until you take your national registry after graduation. However, not every patient knows this. Believe it or not, a lot of patients that I've dealt with have zero knowledge of the examination being performed, nevertheless who reads it, diagnosis it, and plans treatment or therapy afterward. All this information can be very confusing to the average patient but there are ways to educate the patient and to put their concerns at ease, IF you communicate with your patient properly.

One way to help prevent any confusion is to be 1oo% honest from the very second you meet your patient. For instance, when introducing yourself tell them, "Hello, my name is (fill in the blank). I will be the technologist performing your examination today." A lot of times, introducing yourself as the technologist will alarm the patient that you are NOT the physician and can avoid future confusion. Sometimes a patient is under the impression that a physician will be performing their exam. If this is not the case, explain to them that you have been trained and are licensed to perform their examination and that this is the sole purpose of your profession. This should help to inform the patient of your position.

If this doesn't work and the patient is still under the impression that you may be a physician performing their examination, they will generally have questions for you during the exam. For instance, a patient may ask "Will you read these right away?" or "Can you tell me if anythings wrong?". At that point, a typical response should be, "All of the images will be given to our radiologist who will send a report to your referring physician within (time frame here)." This often will put their concerns at ease about who's reading their films.

Once in awhile however, you'll have a patient that will insist you give them a diagnosis even though they know you are not licensed to do so. A common statement will be "I really need to know if there's something wrong, can you tell me?" or "I know you can't tell me if there's anything wrong but can you give me a hint?". Patients will come up with many different reasons as to why they need an answer quickly, however your response needs to always include the phrase "I am not a physician" or "it's beyond my scope of practice". This can get very old and annoying, however I cannot stress the importance of communicating this fact to the patient.

There will be times when you want to inform the patient of something you see on the images just to put their minds at ease and there are definitely times in which you should inform the radiologist of something you might see prior to the discharge of a patient. I'll never forget one particular instance when I had a patient at an outpatient facility that came from a primary care physician with a prescription for a chest x-ray because he had acute shortness of breath. I took the chest x-ray a saw a HUGE pneumothorax in the patient's left lung. I calmly informed the patient that they should have a seat while I showed the radiologist the film. The radiologist interpreted the film immediately and sent the patient to the Emergency Department. It would have been very easy for me to tell the patient prior to showing the film to the radiologist that I knew he had a pneumothorax and that he needed to stay there for a few minutes, but what if I was wrong? Then what? The patient would've been upset without question and if a complaint were to be filed, I would have probably lost my job and possibly my license. It's much easier to be honest with the patient about your position and to abide by your skill set.

The bottom line is, when the patient questions you, always answer within your scope of practice. You will often be certain of a diagnosis after imaging a patient and be completely wrong. So whenever you want to inform the patient of a possible ailment, just remember the old Mark Twain quote "It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt."

Curtis J. Carpenter R.T. (R)(CT)

Curtis J. Carpenter is the founder and president of Reliable Radiography, based in Vero Beach, FL.

Check out the blog at reliableradiography.blogspot.com

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Comment by Tanya Vi on March 23, 2011 at 4:35pm
Very useful article!
Comment by Dr. Mohamed Refaey on March 23, 2011 at 6:28am

It's much easier to be honest with the patient about your position and to abide by your skill set.


totally agree with you, lot of patients have no patience. It's annoying for technologists to answer what's my diagnosis question, when the patient turns to the radiologist they ask what's my treatment ?.

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