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Re: Fetal demise: was routine ultrasound exam From: RModugno@aol.com Mon Mar 14 16:26:37 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more...about..." Previous message: RModugno@aol.com: "Re: Ultrasound as part of the normal exam" In a message dated 3/13/2005 2:37:03 PM Eastern Standard Time, drmiller@enatal.com writes: There's your problem. You are stuck in the paradigm that considers vaginal ultrasound as a "procedure". Is it a "procedure" to take out your stethoscope and listen to a patient's heart or lungs? Is it a "procedure" to look into a patient's eyes with an opthalmoscope? Do you enter a CPT when you do those things? Ultrasound is just another tool that has finally reached a point after 25 years that it is affordable and portable enough to be used routinely in the exam room. Just like most new technology that starts out with use by a few, and then later, use by the masses (e.g. computers, cars, telephone, etc.) Here's something else to get the forum typing - I'm not even sure anyone needs to do a bimanual if the clinician personally does the exam. You can tell real quick about pain and tenderness. >-- in just 15 seconds – that’s fast – must have an extraterrestrial >machine/printer of the third kind You're still thinking "procedure". Ultrasound techs, dozens of pictures, a separate dictated report, huge machines, and CPT codes are all part of a way of thinking that should be replaced. Think "exam". Talk to the patient, put her on the exam table, slip a condom on a vaginal probe, do a survey in about 15 seconds (for normal anatomy), and document your findings. Same thing you're doing now except eliminating much of the guesswork. If things look complicated (e.g. suspicion of cancer, ectopic) send the patient for a procedure and get things like doppler studies. It's time for OBGYNs to take simple ultrasound "procedures" back from the radiologists and bring them into the exam room (but if you don't know what you're doing - "order" the ultrasound procedure). -- Donald W. Miller, Jr., MD, FACOG Agree! Question: When you find a fetal demise - do you send the patient for a "second opinion" even if she does not request one? Robert Modugno MD MBA FACOG Marietta, GA http://www.novaobgyn.com Next message: R. Daniel Braun: "Re: Interesting D&E lawsuit Two more cents, and I'll raise you 2 more...about..." Previous message: RModugno@aol.com: "Re: Ultrasound as part of the normal exam"

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