Beware of Misread X-rays

Recently, we have been contacted by two potential clients about injuries that went undiagnosed despite the fact that x-rays were taken. In both instances the x-rays were taken in the office of a primary care physician – a family doctor or a general clinic – and in each case the doctor who looked at the x-ray failed to identify a significant injury. Because of the misreading of the x-rays, the patients failed to obtain timely medical treatment which resulted in subsequent major surgery and permanent injury.

Every imaging study performed in a hospital, be it an MRI, a CT scan or a plain old fashioned x-ray is “read” by a radiologist; a physician who has specialized training in interpreting imaging studies. Once the x-ray is read, a written report is prepared which goes in the patient’s chart. If the x-ray shows an injury, the treating physician will usually get an immediate call from the radiologist and prompt treatment can be given.

On the other hand, there is no guarantee that an ordinary x-ray taken in the office of a primary care physician or a general clinic will be seen by a radiologist. All physicians have some training in interpreting plain film x-rays. But the amount of such training, which could have been received many years earlier, is not extensive. In one case that we have been consulted on, the primary care physician ordered an x-ray of a foot. After looking at that x-ray, which was taken in his office, the physician erroneously determined that there were no broken bones in the foot. The patient was not sent to a specialist, either a podiatrist or an orthopedist, for treatment, and, as a result, she walked around on a broken foot for a substantial period of time until she took it upon herself to see a podiatrist who promptly diagnosed the break and provided treatment.

What should have been done? The primary care physician should have sent the x-ray to an independent radiologist to be “read”. This is not very difficult since most x-rays can be transmitted electronically. Had it been done in our case, the primary care physician would have promptly learned about the break, and the patient could have been sent to a specialist for treatment immediately.

The lesson to be learned is that a patient should insist that every x-ray taken in a doctor’s office or clinic be sent to a radiologist for interpretation. No self-respecting doctor should refuse that request. If the doctor tries to dissuade you by saying “don’t you trust me”, the answer is simple: ” If I didn’t trust you I wouldn’t be here, but I just want a specialist to double check.” If the doctor still gives you a hard time, get a new doctor.