Q Dr. Cockburn I do not believe in taking x-rays of my patients, even in minor car accidents. When a patient has been in a severe accident (above 10 mph) I refer them to an orthopedist for eval and x-rays, and then I treat them only if he refers them back to me. I think this is the safest way to protect myself legally. What are your thoughts? I have only been out of school for 18 months.
A Well, I would like to begin by stating that I fully understand your anxiety and fear in toady's litigious climate. However, there are several areas of concern that your question has posed and need addressing. I am going to spend some time on this one, as recent grads from around the country have voiced concerns to me in the same area.
First, you are a licensed Doctor of Chiropractic. You have a responsibility, in fact a DUTY, to properly evaluate patients who come to you seeking your professional opinion and advise, let alone your treatment of them. If you do not feel that you are capable of differentiating these trauma cases, or any other case for that matter, then you need some additional training. I think the best place for you to start is by thoroughly reading Foreman and Croft, "Whiplash, the cervical acceleration deceleration injury" (text) and by taking one of Dan Murphy's seminars. This will give you a wonderful overview and documentation necessary to be more "clinical" about your approach.
Second, allowing another clinician to make your decisions for you is DANGEROUS. Have you ever considered the lack of medical training in chiropractic clinical concepts? Also there is a CONTINGENT LIABILITY issue to be considered when you refer to anyone, but especially when you refer outside of your specialty. Have you considered finding a local DC who is knowledgeable to befriend you and give you some guidance? I think this would be helpful.
Now to the issue of x-ray. While I do not believe in the non-judicious utilization of x-rays, I think it is incumbent upon you in trauma cases to perform at least scout series and then if warranted, motion x-rays before giving any treatment. Of course a good intake history and clinical examination is required prior to this decision. Also you need to see Smith V Yohe on this site for information related to negligent practice.
In particular focus to x-ray, the following case may prove helpful to you and others.