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Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more... From: art fougner, md (evsono@pipeline.com) Sat Mar 12 10:28:22 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Ultrasound as part of the normal exam" Previous message: DoctorJoe@aol.com: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more..." In reply to: DoctorJoe@aol.com: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more..." Next in thread: Garry E. Siegel, M.D.: "Ultrasound as part of the normal exam" Reply: Garry E. Siegel, M.D.: "Ultrasound as part of the normal exam" Reply: rmodugno@aol.com: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more..." Thought this was a good idea in early 1991 and thought that as folks left residency, this would slowly come to pass. However, reimbursements have to be at a level commensurate with expenses. otherwise - great idea - especially given this: Obstet Gynecol. 2000 Oct;96(4):593-8. Accuracy of the pelvic examination in detecting adnexal masses. Padilla LA, Radosevich DM, Milad MP. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota 55455, USA. padi0013@tc.umn.edu OBJECTIVE: To estimate sensitivity, specificity, positive predictive value, Youden J statistic, and likelihood ratio of pelvic examination in adnexal assessment under ideal circumstances. METHODS: One hundred forty women consented to have pelvic examinations under general anesthesia before laparoscopy or laparotomy. They were assigned to examiners masked to indications for surgery, including attending gynecologists, gynecology residents, and medical students. Surgeons' findings were compared with examiners' findings. Variables assessed included adnexal diameter, presence of adnexal masses, and effect modifiers such as examiner experience and body mass index. RESULTS: Forty-nine left adnexal and 33 right adnexal masses were found during surgery. Examiners tended to underestimate adnexal size. Sensitivity of pelvic examinations for detecting left adnexal masses was 0.23-0.36 and for right adnexal masses was 0.15-0.28. Positive predictive value was low for left adnexal masses (0.50-0. 69) and right adnexal masses (0.26-0.39). Differences among examiner groups were not statistically significant. Patient obesity noticeably reduced detection of adnexal masses on either side. CONCLUSION: Bimanual pelvic examination has marked limitations for evaluating adnexa, even with ideal circumstances. Experience during postgraduate training in gynecology did not seem to improve examination accuracy. Patient characteristics such as obesity, uterine size, and abdominal scars limit the accurate palpation of the adnexa. art At Sat, 12 Mar 2005, DoctorJoe@aol.com wrote: > >In a message dated 3/12/05 5:38:02 AM, el@lisse.NA writes: > >> I actually do my own sonars. And during my residency whoever did the ToP >> had to do the sonar. I find that accepteable. >> >> <SNIP> >> >> As far as I see it the guy missed a the head. If standard of care in >> your parts is that missing the head is acceptable but Ultrasound is not, >> so be it. >> >> However, I do find this almost as difficult to accept as the >> patient. Though she obviously had dollar signs in front of her eyes. >> >Well, let's step back and look at this. > >SURE, an ultrasound is a fancy-schmancy piece of equipment. And SURE, you can >charge a bunch of money for doing one. And SURE, there are registries and >governing bodies and such that certify people as ultrasonographers. > >BUT -- another reasonable way to look at the "ultrasound" is as an extension >of your physical examination!!!! > >We don't charge extra for applying a stethescope to a patient when the need >arises. And stethescopes DO cost money to buy (although not a lot, granted). >And they're actually based on some of the same physics (i.e. sound waves) as >ultrasonography, although not with the fancy computer calculations to go with it >(although it can be argued that the HUMAN BRAIN that goes behind the >stethescope is worth a lot, too). > >So I'm willing to offer that an end-of-procedure ultrasound, same as a Labor & > Delivery ultrasound, same as any other on-the-spot ultrasound, or physical >examination (stethescope, bimanual, etc.) for reasons related to a procedure or >delivery or whatever SHOULD BE CONSIDERED A NO-BRAINER. > >Now, that's just an opinion which is offered for discussion. So whadyathink, >Listers? The U/S as part of your physical exam, when needed, not an >"independent" technology-rich test. > >Joe P. -- art fougner, md "If you don't know where you are going, you will wind up somewhere else." Lawrence Peter Berra Next message: Garry E. Siegel, M.D.: "Ultrasound as part of the normal exam" Previous message: DoctorJoe@aol.com: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more..." In reply to: DoctorJoe@aol.com: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more..." Next in thread: Garry E. Siegel, M.D.: "Ultrasound as part of the normal exam" Reply: Garry E. Siegel, M.D.: "Ultrasound as part of the normal exam" Reply: rmodugno@aol.com: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more..."

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