The Myth of the X-Ray

And what matters most when treating patients with back pain

If there's one thing I want people to know about technology, with all its advancements and innovations over the years, it's this: nothing trumps a savvy doctor's evaluation coupled with a thoughtful patient's personal assessment. X-ray technology, pioneered by Wilhelm Rontgen in the late 1800s, has provided the medical community with a powerful tool to help aid in the diagnosis of a number of illnesses and conditions for more than 100 years. But the key words to focus on here are tool and aid. X-ray machines are not doctors. They cannot tell us how to treat a patient or to what extent that patient needs treatment. No, the smartest technology in getting to the bottom of and eventually alleviating chronic back pain is the relationship between the doctor and his or her patient.Doctor with patient discussing X-ray imageOver my course of years in practice, I have seen thousands of x-rays. Some have shown a mild or beginning stage of spinal degeneration, others have presented such severe damage that I've marveled at how the patient was even able to walk through my office door. But nothing prepares me better for which course of treatment I eventually recommend than the patient. In his or her own words, telling me how what I see on the x-ray is making them feel. When a patient presents in my office with a mild scoliosis curve, picked up on an x-ray for another medical reason entirely, they're often plagued with worry and questions. Will it get worse? Will I need surgery to fix it? Will I become wheelchair-bound?

I know you're not supposed to answer a question with a question, but I do it a lot. When the patient's questions subside and their anxiety is at its peak, I simply ask: Well, how do you feel? Have you had to change your lifestyle to accomodate what we're seeing on these x-rays? Have you tried conservative techniques to manage the pain (if there is any present)?

In many cases, after I've asked these questions, I can see the worry subside almost instantly. Because the truth is that no matter what that x-ray shows, my patients know best how they feel. And the answers to most of those questions I ask? With slight variations, they are: "I feel fine," "No, I still play tennis twice a week," and/or "No. I don't do anything for the pain. Just let it eventually pass."

Now of course, there are plenty of instances where the answers to those questions are different. I do consult with many patients in severe, debilitating pain, who have tried just about every conservative treatment method under the sun and to no avail. But again, the x-ray didn't tell me all of that. An open, honest dialogue with my intelligent patient did.

What I always encourage the medical students and fellows I encounter in the teaching side of my profession to do: "Put down the x-ray and talk to your patient." Technology is wonderful, but it won't paint the complete picture for us doctors. We ned to pick up the brush and so do our patients, to paint together what will hopefully be the masterpiece they require for lasting back pain relief.