Radiology in family practice: experience in community practice

This study examined the utilization and interpretation of office x-rays in community practice. Analysis of physician and practice descriptive data obtained by survey from the Minnesota Academy of Family Physicians Research Network, a representative sample of family physicians in Minnesota, leads to these conclusions: (1) Most (87.3%) of the study physicians have on-site x-ray facilities. (2) An extensive variety of x-rays is obtained in the office. (3) Most (54.2%) family physicians interpret their own x-rays and self-select those they want re-read by a radiologist; 43.8% referred all x-rays to a radiologist. (4) Of those who self-select x-rays for referral, 68.9% refer 10% or fewer films. (5) Reasons for referral are: (a) to follow an "a priori" decision, (b) to make a diagnosis when clinical findings are inconclusive, (c) to confirm the physician's own clinical diagnosis, (d) to protect from medical-legal problems, and (e) to consult because of the seriousness of the problem. The study physicians also believe that the interpretation of office x-rays is a basic skill of the family physician, that residents should be trained to interpret 90% or more of their office x-rays, and that radiologists should be used as consultants on the basis of identified need similar to the way other consultants are used. The study also showed that decision criteria for referral are based on sound clinical and quality of care issues, that liability concerns have a definite influence on referral rates for x-ray interpretation, and that a contractual reading arrangement with a radiologist and close proximity to a radiologist both tend to increase his or her use.