Re: Nuchal Cord
From: Szyller (szyller@noos.fr)
Sun Feb 22 04:16:29 2004
Hi,
I am interested knowing how MD specialized in obgyn ultrasounds work in
the US, between having sonographers as" eyes" and not managing the patients.
(I am a french obgyn and my activity is getting overtime focused on
ultrasounds, I have lately received my ECFMG certification and I know
try to find a position for my training in the US )
Sincerely yours
Alain H.Szyller, MD
Philippe Jeanty wrote:
>This is an excellent point that I realized I had not touched. Telling
>findings is very different from offering opinions about management ! That is
>a sure way to get into conflicts. When the patient presses me to tell her
>management options:
>1) I just provide broad information
>2) I tell her that I am not qualified to make that decision
>3) that her referring MD has a much more complete picture of her situation
>and that together they will explore the best approach in HER case.
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of laure
>Sent: Saturday, February 21, 2004 4:28 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>Hi,
>
>I am a obgyn physician from Spain. The figure of sonographers don´t exist
>here, but more or less is the same whe you make an eco for another
>physician. I allways say to my patients all I´ve seen, with my personal
>opinion of its meaning and prognosis. In case of other physician´s patients,
>I never tell her nothing about management, just what I´ve seen, because I
>don´t know what is the intention of others.
>In a nuchal cord, I just invite my patients to make a cardiotocographer
>register at the begining of labor, instead of wait till clear labor
>condition.
>As the saying goes; by the mouth, dies the fish. Most of the litigations
>begin with two diferents opinions.
>
>L. Folgar
>County Area Specialist obgyn physician
>Melilla
>Spain
>
>-----Mensaje original-----
>De: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]En nombre de Sue
>Davies
>Enviado el: Sábado, 21 de Febrero de 2004 04:30 a.m.
>Para: Multiple recipients of list ULTRASOUND
>Asunto: RE: Nuchal Cord
>
>Sorry Terry, I read my emails back to front!!
>I believe that sonographers who are well trained make these sorts of
>descisions all the time. The central issue here is TEAM WORK - if physicians
>and sonographers work as a team then there is rarely any difficulty. We,
>like Dr. Jeanty's team, know what our colleagues expect and how they usually
>deal with many situations and behave accordingly. For the case in point, if
>I saw a cord draped over the babies shoulder, I would make no comment -
>since that is the policy our team has decided upon. If the cord is wrapped
>tightly or more than twice - then we comment. Once again, I believe that the
>physician who started this discussion should talk to the sonographer or
>radiology department involved and resort to some team work.
>
>Cheers
>
> Sue Davies
>Program Director
>PO Box 434
>Mermaid Beach, Q, 4218
>tel: (07) 5526-6655
>http://www.aiu.edu.au
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>DuBose, Terry
>Sent: Saturday, 21 February 2004 12:08 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>Sue, what you say is true. However, it still does not answer the question
>of what a sonographer should do when they observe a nuchal cord, which is
>just across the fetal shoulder and not wrapped tightly
>around the neck or 2-3 loops around the neck.
>
>As I understood the original question, the physician did not think it was
>important and did not want the sonographer to draw attention to the nuchal
>cord (comment or record images) because the physician then felt
>obligated to comment in the report. I have worked with physicians who
>also did not want incidental findings recorded because they then felt
>obligated to comment.
>
>So the question remains, should the sonographer ignore conditions which they
>believe are insignificant or not, or should they give all information to the
>physician and let her/him make the decision?
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
>Assistant Professor & Director
>Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP
>4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA
>501-686-6510
>DuBoseTerryJ@UAMS.edu
>http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Sue
>Davies
>Sent: Thursday, February 19, 2004 8:07 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>I agree Terry, that is why referring physicians should discuss such things
>with both the radiologists and the sonographers in their area so that all
>are aware of what is considered best for their particular needs.
>
>Cheers
>
> Sue Davies
>Program Director
>PO Box 434
>Mermaid Beach, Q, 4218
>tel: (07) 5526-6655
>http://www.aiu.edu.au
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>DuBose, Terry
>Sent: Friday, 20 February 2004 10:44 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>As I understood the original question, it was not the sonographer telling
>the patient about the cord, but the physician did not want to know if the
>cord was just draped over the fetal shoulder, with a film showing this,
>because the physician then felt obligated to comment in the report about in
>case there was a poor outcome.
>
>So should the sonographer take a picture of a nuchal cord that does not
>encircle the neck two or more times? Or ignore it... that is the
>question, as I understand it.
>
>Sonographers are expected to take diagnostic images, but not considered a
>diagnostician, even though their credential is "Registered Diagnostic
>Medical Sonographer". They are between a rock and a hard place with many
>physicians.
>
>Peace, Terry J. DuBose, M.S. RDMS
>Little Rock, Arkansas
>
>------------------------------------
> I absolutely agree......why is a sonographer telling the patient about
>------------------------------------
>the cord? Perhaps a policy should be put in place that the sonographer
>------------------------------------
>tells the doc about the cord, then leaves it up to the doc to tell the pt.
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
>Assistant Professor & Director
>Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP
>4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA
>501-686-6510
>DuBoseTerryJ@UAMS.edu
>http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>-----Original Message-----
>---------------------------------------------------------------
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>Ilvlucy@aol.com
>Sent: Thursday, February 19, 2004 5:19 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>In a message dated 2/19/2004 4:28:18 PM Central Standard Time,
>sue@aiu.edu.au writes:
>
> If I could buy into this one - surely a sonographer is duty bound to
>examine
> the fetus in all its aspects and document the findings. We routinely
>include
> cord examination in third trimester scans, it is the obstetrician's
>duty to
> discuss the results with the patient and make decisions on
>management, if a
> sonographer finds a nuchal cord wrapped securely (3 or 4 times
> circumferentially) and does not report this, they would be liable
>for
> censure if anything went wrong. Maybe the best outcome for your
>current
> difficulty would come from the referring physicians having a
>discussion with
> the sonographer in question and make them aware of their cocerns
>
> Cheers
>
> I absolutely agree......why is a sonographer telling the patient about
>the cord? Perhaps a policy should be put in place that the sonographer
>tells the doc about the cord, then leaves it up to the doc to tell the pt.
>
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