Intended for healthcare professionals

Rapid response to:

Endgames Spot Diagnosis

A plain radiograph in back pain

BMJ 2016; 355 doi: (Published 06 October 2016) Cite this as: BMJ 2016;355:i5003

Rapid Response:

Putting oneself into the shoes of another doctor

Dear Editors

Considering the entire generations of GPs in recent years drilled into following the NICE recommendations and RCGP guidelines on imaging for lower back pain, the patient mentioned in this case would not have gotten his lumbar spine X-ray since there are no real red flag in the presenting symptoms, particularly when the severity of the pain by itself is not a commonly accepted red flag per se.

In fact, under the current regime in the NHS, the young man at the hands of a GP following guidelines would have got an MRI spine rather than the lumbar X-rays; the latter possibly simpler and yet displays widely accepted radiological characteristics of ankylosing spondylitis, than MRI would have.

The authors and fellow readers may want to keep in mind that this case history may not reflect a typical course of event nowadays for a young patient presenting to his GP with severe lower back pain with no red flag.

Competing interests: No competing interests

11 October 2016
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia