Be an expert...

I received an urgent call from an existing patient, a professional basketball player, informing me that he injured his toe by accidentally ramming it into a sofa. About 15 minutes later, he limped into my office  with a swollen and bruised left foot. Following my physical exam and considering the mechanisms contributing to his injury, I performed acupuncture to reduce his pain. Although he was feeling much better after the treatment, I urged him to get an X-ray immediately as he was scheduled to travel overseas within the next week.. 

We referred him to a nearby imaging center to get his foot X-rayed. Happily, he returned to my office about a half hour later with a CD of his X-Ray image in hand -- and without limping! 

I immediately loaded the CD into my computer and found that it wasn't the 4th toe that had been injured as our physical exam suggested.  Surprisingly, it appeared to be the 5th toe that showed an oblique non-displaced fracture on the proximal phalanx. I told him that in order for him to comfortably leave on his trip, he would need to see me every other day for acupuncture treatments. 

The next day I received his report from the radiologist which was shocking to me as it reported there as no fracture or dislocation, and that all joints, ligaments and soft tissue appeared normal. I immediately reviewed the X-rays again with Dr. Eric Wang, my associate, we both believed that there was indeed a fracture. Acknowledging that neither of us was a radiologist, we emailed the foot X-ray images to the owner of the Imaging Center, requesting him to explain what we saw on the images. The owner happens to be a very experienced chiropractor. Afraid he'd be too busy to read my email immediately. I also sent him a text message to remind him of my email request. Within minutes, he replied with "I see it and will call for 2nd read." 

In less than 15 minutes, I received the second report issued by another MD radiologist to confirm that there was indeed an oblique non-displaced fracture through the base of the 5th phalanx. Reading the second report and looking at the obvious fracture on my computer screen, I had a mixed feeling-pride and frustration. Of course, my associate and I were excited that we were right about our findings. On the other hand,we also wondered what why the first MD radiologist did not read the X-rays correctly. Was he drunk or did he look at a totally different patient's foot or body part? 

We know radiologists have had much better training and read more imaging tests than we do. However, carefully correlating imaging tests with clinical findings is also an important skill. Yes, we may be non-MD licensed acupuncturists, but we routinely demonstrate that we are THE acupuncturists who are also able analyze X-ray images. 

This case reminds me of my trip to Denver as the keynote for the 2010 symposium of Colorado Acupuncture Association. I was reading a magazine on the plane and totally impressed by a marketing slogan: Don't just follow the experts. Be ONE! 

Edited by Tom Rigoli, Ph. D.