I recently reviewed films for a doctor on a personal injury case where there were comparison studies documenting an occult fracture of the pars at L5. The pre-injury films demonstrated a normal lumbar spine. These films had the patient's name identified with only a paper label and not photographically identified on the x-ray film. The post-injury films demonstrated a fracture of the pars at L5 only on the right side. There was no evidence of a spondylolisthesis. These later films were identified properly by photographically marking the x-ray films.
The question was raised by the defendant's attorney that the earlier films could possibly be of a different patient. It was suggested that these films should not be submitted to document this patient's injury because the identification label could have been changed to read any name. Of course this line of questioning did not help the plaintiff's case. We were forced to submit the patient to a bone scan in order to document the fracture and establish that it was a recent injury. This added another expense to an already costly case.
It is imperative that we properly identify all films. This is extremely important in comparison studies, follow-up examinations, and for medicolegal cases. The proper identification should include the following information:
Other information that is not essential but is suggested:
An older method, but still just as efficient, is the aluminum marker plate which has grooves for the placement of lead numbers and letters for labeling the film when the exposure is performed on the patient.
The most recent advanced method to date is with an identification camera in conjunction with cassettes. The cassette is inserted into the camera, a slide cover on the cassette is open and the identification exposure is made. This exposure is automatically timed so that you can never over or underexpose the marker.
The time spent performing the task of identifying your films will save you the embarrassment of criticism in the courtroom and will better protect your patients.
Deborah Pate, D.C., D.A.C.B.R.
San Diego, California
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
