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General practitioners' willingness to request plain lumbar spine radiographic examinations
O P Ryynänen1, J Lehtovirta, S Soimakallio
1Department of Community Health and General Practice, University of Kuopio, Finland. ollipekka.ryynanen@uku.fi
Objectives:
To examine general practitioners' attitudes to plain lumbar spine radiographic examinations.
Design:
A postal questionnaire consisting of questions on background data and doctors' opinions about plain lumbar spine radiographic examinations, as well as eight vignettes (imaginary patient cases) presenting indications for lumbar radiography, and five vignettes focusing on the doctors' willingness to request lumbar radiography on the basis of patients' age and duration of symptoms. The data were analysed according to the doctor's age, sex, workplace and the medical school of graduation.
Setting:
Finland.
Subjects:
Six hundred and fifteen randomly selected physicians working in primary health care (64% of original target group).
Results:
The vignettes revealed that the use of plain lumbar radiographic examination varied between 26 and 88%. Patient's age and radiation protection were the most prominent factors influencing doctors' decisions to request lumbar radiographies. Only slight differences were observed between the attitudes of male and female doctors, as well as between young and older doctors. Doctors' willingness to request lumbar radiographies increased with the patient's age in most vignettes. The duration of patients' symptoms had a dramatic effect on the doctor's decision: in all vignettes, doctors were more likely to request lumbar radiography when patient's symptoms had exceeded 4 weeks.
Conclusions:
General practitioners commonly use plain lumbar spine radiographic examinations, despite its limited value in the diagnosis of low back pain. Further consensus and medical education is needed to clarify the indications for plain lumbar radiographic examination.