Alright, so I'm a history channel buff, and I couldn't resist uploading their logo :-)How many times have you received a requisition or a Physician's order for an exam without any patient history or diagnosis? Or even worse, there is a symptom listed that has nothing to do with the body part ordered, i.e. a Chest x-ray order that states "pain in left foot." Here are a few guidelines to acquiring a good general history to help the Radiologist and to create warm fuzzies throughout the department:
Talk to your patient. It sounds so simple, but we all know that chatter can be somewhat limited during a busy day. Take the time to ask them why they were admitted into the hospital or why their doctor ordered the exam.
Be a 3 year-old. Have you ever noticed that 3 year-olds ask you "why" a million times. You can do the same thing with your patients, but maybe tone it down just a bit. For example, ask "why are you having a chest x-ray?" If the patient says, "I have a cough," don't simply stop there and write "cough" on your requisition. What kind of cough? Dry or productive? Clear sputum or thick yellow gunk? Blood in sputum? Are you a smoker? Any history of asthma or emphysema? How long have you been coughing? Have you had a fever since you started coughing? If they are having a foot x-ray for pain, ask where... don't simply write "pain on the side of the foot." The Radiologist should be able to tell exactly where the pain is without looking at any annotated arrows on your image. "Pain at the base of the 5th metatarsal s/p trauma 1 week ago. Contusion at the site and soft tissue swelling present."
There's always the chance that the patient states they have no clue why they are having an x-ray. There could be a couple of reasons for this... it could mean that the physician has not communicated the reason, in which case it should be written on the prescription. If it is not, take the time to call the physician so you can provide an adequate history for the Radiologist. Checking the patient's chart can also be a very simple, yet easily overlooked option. You can also go back to the beginning... just ask why the patient originally went to see their physician to begin with. Some history is better than no history.
There's always the challenge of the non-english speaking patient. A good way to acquire a history from these patients would be to enlist the assistance of a family member or coworker who might speak english and the language you don't know. Nobody around who speaks that language? Most facilities will have a contract with a 24-hour phone service that will translate for you. It might take a little bit of time and effort, but taking this time prior to the exam being performed could save you a lot of time, frustration, and energy later.
Histories for studies involving contrast or invasive procedures are extremely important. Of course, when injecting or ingesting contrast, it is important to note any allergies, prior surgeries (date, type, and location) and any current medications the patient is on. Depending on the answer to these, you could quite possibly identify a contraindication for the study you are about to perform, and the Radiologist will really appreciate your thorough history-taking skills. Common contraindications may include the following:
Possible perforation of bowel on barium studies - we don't want cement-forming barium leaking into the mediastinum or peritoneal cavity!
Patient on anticoagulants for arthrograms or myelograms - it will take quite a bit of effort to get any bleeding to stop, and if you are puncturing the dural sac, you will risk spinal fluid leak after the patient leaves.
Patient on glucophage when performing a contrast injection - this could over-work the kidneys and glucophage should be avoided for at least 48 hours post contrast injection (check department policy and patient's physician to ensure they can go without the medication for that long).
Patient had recent biopsy of colon prior to BE - any additional pressure on the bowel wall of contrast and/or air could cause a perforation in a weakened region of the bowel.
Patients in renal failure - we don't want to further contribute to the workload of the kidneys by injecting our syrup-like contrast... if the patient is on dialysis, contrast injections may be able to occur if dialysis immediately follows the injection and should be coordinated with the ordering physician and radiologist.
General allergies - we all know what can happen if we don't screen for allergies appropriately.
All of these things in combination will keep the patient safe, the order physician happy, ensuring trust in you by the Radiologist, and increase your level of competence as a Radiographer. A few minutes prior to a procedure for a thorough history can prevent a life time of trouble for all.
