Showing x-rays to patients

Many dentists like to show x-rays to patients in order to prove what they’re saying is true. They think that by putting x-rays up on the screen the patient will suddenly be convinced and proceed with treatment.

Dentist: “See those black spots between the teeth. They’re holes.”

Patient (squinting at the x-rays): “Which black spots?”

Dentist (getting a bit impatient): “Those ones just there. See! See!”

Patient (confused): “What are the white things?”

The problem is, reading x-rays takes training and experience. I learnt that when a friend who had an arthritic shoulder put the x-ray of his joint on facebook. He was trying to show how bad his condition was. Even though I’ve read dental x-rays for 30+ years, I couldn’t see a thing. It might have been a normal shoulder or it might have been bad; I couldn’t tell.

There’s a scene from the old medical drama, Dr Ben Casey, that illustrates how patients can’t read x-rays. Dr Casey wants to show the patient what’s wrong so he holds up the spinal x-ray for the patient to look at. The patient has no idea: “Ah, the Mississippi and all its tributaries.”

Surprisingly, I’ve even found practicing dentists who can’t read dental x-rays. A majority of new graduates (and some more senior dentists) who I’ve reviewed struggle with diagnosing inter-proximal decay and periapical lesions. If some dentists have difficulty reading x-rays then patients have no hope.

Patients don’t know what pathology looks like so they have to take your word for it. Showing x-rays to patients is just an attempt at justification. You think that you’re proving your case but what you’re really doing is confusing patients and making them even more uncertain.

If you want to use x-rays to prove your diagnosis to a patient then there’s a simple way. Look intently at the x-ray for a few moments. Then look the patient in the eye and say to them: “The x-ray shows an infection.” or “Your x-rays shows six holes.”

Back in the ancient days when x-rays were film stapled onto clear sheets of plastic, I had a patient demand with an accusatory tone to see his x-rays. Without any hesitation I said sure and handed him the plastic sheet. He looked at it upside down, sideways and backwards. After 30 seconds or so he handed it back to me and said OK.

Please stop showing x-rays to patients. It’s a waste of time.