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Re: Ultrasound as part of the normal examFrom: Charlie Chambers (cchamber@gorge.net)Sun Mar 13 19:57:13 2005
I do think before we start doing "15 second" ultrasounds on everyone that we figure the cost of doing such a practice. How many functional cysts are going to be removed, and how many small myomas will have to be followed? Ultrasound has been shown to be a remarkable tool but not much of a screening tool for ovarian cancer. As to AIUM, I think that they serve a useful purpose. Of course, I am biased given that we are accredited. But, frankly, I find it a little distressing that a provider who just purchased a machine and can do a femur length and find the stomach bubble after being taught by the rep is not only billing for a complete exam that might take me a half hour or more to do, but the patient is no less the wiser. If you look at the guidelines for provision of ob or gyn ultrasounds by AIUM, they are very reasonable. The list of required structures would certainly be agreeable to the majority of practictioners. As to the case of the D and E, what real harm was done? If no definable harm was done, then any questions to standard of care are interesting but academic. Anything subsequent to the trauma of a loss of a pregnancy seems trivial. ************************************************************************ ** Charlie Chambers Hood River, OR USA cchamber@alumni. rice. edu "I'm a goin fishin. Yeah, I'm goin fishin And my baby's goin fishin too!" Taj Mahal ************************************************************************ On Mar 13, 2005, at 6:14 PM, R. Daniel Braun wrote:
-- > I guarantee you that they aren't. I also agree with you that they > should be. > > It isn't the AIUM that will hang you, it is the expert witness quoting > their guidelines in court that will. > > On Sun, 13 Mar 2005 18:15:35 -0600, Don Miller <drmiller@enatal.com> > wrote: >> At Sun, 13 Mar 2005, R. Daniel Braun wrote: >>> >>> And the AIUM is out there waiting to hang you for performing an >>> inadequate procedure whatever you call it . They have guidelines >>> which >>> require a complete exam with documentation everytime the transducer >>> meets the tissue. >> >> The AIUM is predominantly populated with radiologists and others >> defending their turf (i.e. referral base) and maintaining the status >> quo no matter how clinically backward it is in 2005. I was a member >> for >> years. The AIUM may be unwilling to change their paradigms for >> assorted >> reasons not necessarily for better patient care. >> >> Do you think AIUM wants to "hang" physicians for using portable >> ultrasounds units in L&D? >> >> Unfortunately, my guess is that many OBGYNs are not facile enough to >> do >> the exams I advocate, nor do they have the time to learn, so the >> status >> quo will remain the status quo until innovative physicians lead the >> way >> and the market responds (or 10-15 years after studies show benefit). >> >> I only hope that all residents leaving OBGYN programs are completely >> comfortable doing exactly what I advocate for that is the future. >> >> -- >> Donald W. Miller, Jr., MD, FACOG >> eNATAL, LLC >> http://www.eNATAL.com >> > > -- > R. Daniel Braun > Kinky for Governor >
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