Patient as part of their job as

care and safty has always been an important part of the radiography profession.
Patients with knee and ankle pain often present to emergency departments and
urgent car centers. The majority of those patient (85% – 90%) are presenting
with minor injuries, and most likely do not have a fracture. Asking the patient
about the severity of their injury can lead to shared decision making regarding
the need for imaging, and might reduce unnecessary radiation by simplifying the
process for physicians. The need to image patients with obvious sign of
fracture is never in question, but when the signs are absent or not clear, the
need for imaging is not necessary.


            Radiography remains the imaging
standard for fracture detection after trauma. However, fractures continue to be
the most common type of missed injuries, but physicians continue to order radiographs
to their patient as part of their job as healthcare providers. There has been
multiple studies on the use of shared decision making in specific conditions,
and it is recognized as a way to enhance patient satisfaction on whether the
patient should receive x-ray or not. The Physician would ask the patient the
question “Do you think you have anything broken?” which is still clinically
useful- as it reveals patient expectations regarding imaging and help patient’s
engagement in the shared decision-making process.  If both the patient and the physician agree
that fracture is extremely unlikely, physicians may well feel comfortable that
imaging is not necessary.  213 patients
were enrolled in the study, 219 of which with bone injuries. The patients were
in the ages of 18 and older, and they were asked to sign consent before
participating. Patients were not included in the study if they had any of the following
conditions: obvious fracture (open fracture), dislocation, arrival via ambulance,
injury to the torso, any concern for foreign body, or non-traumatic pain. The study
was conducted from November 2011 to January 2015. The result was 45.6% upper extremity,
and 54.6% lower extremity injuries, and 27.7% of the injuries had positive
radiographic findings; which includes 51 fractures and 3 fingers dislocations.  The physicians did not order images if the patients
answer to any of the questions were “defiantly not.”  Standard emergency department suggest, that
radiographs should be regularly ordered for every patient who presents with
bone injury; therefore radiographs are the most commonly ordered images for
traumatic injury.  Even though emergency
department physicians can distinguish between fracture and non-fracture bones,
they will still order radiographs for any patients with severe bone
injury.  Reasons to order radiographs can
include: fear of lawsuit, failure to meet patient expectation, and fear of misdiagnosis.  Even when the patients are included in the decision-making
process, they most likely will follow their physician advice regardless of the
cost or the unnecessary radiation exposure. However, when the health care
providers explain treatment options and alternatives, and also by providing the
necessary resources, would help patients to choose the best option. In the
study that was conducted, most patients preferred to let the physician make the
decision for them, so that they will not be held responsible for any
misdiagnosis. Experienced emergency department physicians, can accurately
predict which patients have less than 10% chance of bone fracture and therefore
they can determine the need for imaging. 

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In conclusion, physicians can influence patient
decision, by educating the patient about the different treatment option that
can be offered as a way to reduce the need for imaging and to enhance patient care
after all.