I hear a lot of clinicians say that they order unnecessary x-rays because patients demand them.  There are probably some situations where that is inevitable.  But before resigning yourself to role of taking your patients “order,” consider whether a more open communication approach might help.

For example, I found the Ottawa ankle rules to be impractical because patients always wanted the x-rays.  But then I started introducing the Ottowa ankle rules to patients before performing them.  The patients could see the logic of this approach and now it is rare for a patient to demand an unnecessary x-ray (though some inevitably do of course).

Patients almost always trust the physical examination, as long as it is explained to them and the physician is able to explain the evidence for it.

Take home points:

If you want patients to trust your physical examination, explain it to them


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