Re: Ultrasound as part of the normal exam
From: Adilson Esquerdo Lopes (dr.adilson@uol.com.br)
Tue Mar 15 11:07:54 2005
I agree with you, Dr. Miller...
I do my yours words.
"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)".
Dr. Adilson E. Lopes
OBGYN
>----- Original Message -----
From: "Don Miller" <drmiller@enatal.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Sunday, March 13, 2005 4:36 PM
Subject: Re: Ultrasound as part of the normal exam
> At Sun, 13 Mar 2005, Efrain Ramirez wrote:
> >
> >IMHO there should be some kind of reasoning for performing a procedure -
>
> 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
> eNATAL, LLC
> http://www.eNATAL.com
>
