After one has done a good history and physical exam and reviewed the labs, sometimes imaging helps us. The master diagnostician has several responsibilities. The diagnostician should order the appropriate test and review the results. When confused one should go to radiology to discuss the results with the radiologist.
Again we must remember that images have sensitivities and specificities. We make a mistake when we rely on imaging too much or we accept the interpretation without reviewing the films ourselves.
Imaging has test characteristics. In general it does better at suggesting disease than excluding disease.
Ordering the proper test is our biggest challenge. We should strive to not order too many tests. We should work to order tests only when our history and physical point towards a clear reason for the test.
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"We should work to order tests only when our history and physical point towards a clear reason for the test."
Not so sure that is true.There are many times when we do not know what is going on when we have to shotgun a little. The history and physical can only take us so far in so many situations. On top of which there are times when we want to confirm what we know to be true as a matter of follow-up. Then there are times when we don't know if a test is useful or not in an uncertain situation.
The idea we order too many tests is a half-truth. In far too many situations we order too many tests we don't need but in certain situations we don't order tests we should have.That's why I'm against the blanket statement "we order too many tests". Residents hear that and they immediately start cutting their ordering without an understanding of what they are doing.
I think a better way of stating a remedy to the problem is the converse - "avoid tests when there is no clear reason to do them". Subtle but important distinction.