Q: Hey doc.....quick question for you.....I will be starting my practice soon, and have mixed feelings about putting an x-ray unit in......what are your thoughts on not having x-ray in office? There is a hospital a mile or two down the road that has a separate x-ray section, and they would gladly do my x-rays and send me copies.......any input is greatly appreciated!! A: Thanks for your e-mail and question. If you took my class you would know my answer to this question. In terms of business and practice management it is my opinion that you should own your x-ray machine. There probably are plenty of used units .. even quite old .. that will take sufficent and quality films until you can afford to purchase or lease one outright. I幟 sure you can lease one from a x-ray supplier for little if nothing down .. total unit usually costs $12-15000. Every step a new patient has to take to become a patient is a step they may fall off or and get lost in the shuffle. The concept to send patients to another DC .. MD .. hospital is just too overwjhelming for a new patient. The litigious society we live in warrants you have films on almost all your patients using proper judgment .. therefore getting in the habit .. off the bat .. of doing without films is both poor business and practice as well as a risk management concern. Just give thought of what a patient would have to do to get films taken in the hopsital. First to the business office to decide who is paying .. then to the radiology section to wait for films in a medical enviornment .. I recommend you get your own and be frugal with othjer expenses in the meantime. I am copying a section frpom my Smart Start Book as part of my class lecture on this topic. If you wish to purchase my Smart Start Book ($59.95) or my PI Workbook ($20) or Workshop Workbook ($20) or the PR and Marketing Book ($20) or a document disk for the Smart Start Book with the forms and letters and a complete narrative with ratings for Windows and Mac (please request which) ($15) .. you can do it on-line at http://www.chirostore.com/cgi-bin/netcat.pl?page=cat8.htm .. or call my office at 770-491- 3639 and order it directly. Have a Great Day Dr. M X-rays: The conclusion of the physical examination brings us to the X-ray. Usually patients do not object to films, but if they do, you must be firm and position yourself in authority. We should never question the risks of radiation, but in reality, the exposures via our films are limited and not a major health factor. Your machine and cassettes should be updated with quick screens, and proper containment of secondary rays. Accepting this as a given, you must consider the professional risks without an x-ray. Risk Management: If, for what ever reason, you were to irritate the patient廣 condition and they eventually file a malpractice suit against you, what幢l be your defense of not taking X-rays? Will you tell them your technic doesn廠 require an X-ray? Great, they幢l find 10 other D.C廣 using your same technic that agree X-rays are always part of their examination procedures. Will you tell the jury that the patient couldn廠 afford it? Well, that won廠 work either, if it is necessary for those that can afford it, it must also be necessary for those that cannot. Patient Objections to X-rays: If you feel the patient cannot afford this expense .. take it for a reduced fee or for nothing, but if you have no objection to x-rays in general .. all new patients must have an X-ray. Of course, you may use judgment as to exceptions: pregnancy, young children, but these should be the exception, possibly taken with protective procedures. Your judgment and technic procedures should dictate your need and types of X-rays. Your views should reflect your need to determine a biomechanical diagnosis and areas of structural instability. If fees are a factor, multiple views may be unnecessary, as spot AP and lateral views may rule out any risk factors. If x-rays have recently been taken at another facility, it is prudent to call the other chiropractor to get their listing, impressions, or just an okay to adjust prior to the films being mailed to your office. If the patient was seen in a hospital or medical physician廣 office, you can call and have them fax their radiology report to you. If you are strong with your purpose, the patient will respect your integrity and have the x-rays taken at your office. As will often be the case ... use sound judgment. Should you own your own equipment: Due to the expense of a new X-rays unit, some new doctors decide to have another office take their patient廣 films, or send them to the local medical facility. It is my opinion that this is an unwise decision. Often X-rays are needed at the time of the initial office visit, and any attempt to have them leave your office and go somewhere else is poor practice procedure. I recommend that X-rays be a necessary part of any new office expense. You幢l have to bite the expensive bullet. There are a number of X-ray suppliers with used equipment that can be updated and replaced as you grow. Get the machine and be ahead, not always behind in practice growth and patient management.