Chest x-ray on patients’ request

Family physicians are frequently approached by patients of all ages, usually asymptomatic, who request chest x-ray because “it’s been a long time since the last one.” Would you perform the study in such cases?

Julian Dobranowski: The question is whether we should be ordering tests on asymptomatic patients because they request it. From a quality perspective we should only order a test if we know that the result of that test is going to change the way we manage patients. The answer to that question is no, we should not be ordering that test. But because many patients are reluctant to talk about their symptoms, I would use that opportunity if they brought this up to ask questions more specifically. Maybe there is something that they are worried about and that is why they have asked for that chest x-ray. Get that out of the patient. Find out if they are truly symptomatic or asymptomatic. If the patients are symptomatic and we cannot find those symptoms, then we order a diagnostic computed tomography (CT) scan to eliminate disease.