Practical Radiology chest x-ray Edward Weber

See the Patient: Advice for Students from Dr. Edward Weber

Today’s post comes to us from guest blogger Edward C. Weber, DO, lead author of Practical Radiology: A Symptom-Based Approach.

We used to be critical of labeling patients with their disease. Now it is getting worse: instead of referring to specific patient issues, we tag “cases” with standardized CPT coding numbers. It seems like “The System” is winning.

When lecturing on the basics of radiological anatomy to first year medical students, I always start out by projecting a PA chest radiograph and asking the class, “What do you see?” Hands go up and the bright-eyed, eager medical students shout out that they see “a chest x-ray.” That is exactly what all of them say; they see a chest x-ray.

Then I tell them that is not what I see.

I see a patient who is scared to death that their chest radiograph will reveal some horrible disease.

I see a patient who has a large insurance deductible and is already on the brink of insolvency – so if I over-read the radiograph and recommend an unnecessary CT scan I could do major damage to that patient financially.

I see a patient who just might have a small and curable lung cancer. If I miss it on this chest radiograph, I could carelessly throw away that patient’s chance of living a normal life span.

I see a patient who has had a problem that his or her physician has not yet figured out, and IF I knew what that problem was, I could make some cogent recommendations for more advanced imaging that would establish a diagnosis. Or perhaps I don’t have that information and/or just don’t care, and I could just make it easy on myself and give a standard automated normal report, and quickly go on to the next “case”.

I could do this with any number of other examples. For example: the normal hip radiographs, in which I try to see not a hip, but a patient with hip pain. There is a difference. See the patient!


Ed Weber started out with a surgical internship at Philadelphia’s Albert Einstein Medical Center and then stayed there for his radiology residency. He just retired from his primary clinical practice but still consults, loves to teach and write, and loves going to the Cleveland zoo with his 15 month old grandaughter. He wants to teach her to ski and to sail, but not until she is two.

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