Q:

Dear Dr. Margolies,

First let me tell you that I think your advice is
awesome, I am going to buy your books to help me get
going.  I have been in practice for a year, and have
been wondering about whether to make it a practice to
Xray my new patients (not pregnant women, or kids). I
have been having a hard time with patient retention,
and I am not sure if not having an Xray is part of my
problem.  There is also the liability issue, I know I
probably should know what the underlying structure is.
 I guess I am afraid that patients will think that I
am xraying them just to scare them into treatments.

I hope this makes sense, I respect your opinion. 

A:

Thanks for your e-mail. Below my message below is a page from my Smart Start Book. 
This was in chapter three when I discuss report of findings .. it was text for my class on 
strating a practice when I taught at LUCC. X-rays are important for many reasons .. 
retaining patients takes more than an x-ray it is based on value .. how much they perceive 
and how much you place on it. Get this portion down and the rest is easy.

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.