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Re: Ultrasound--diagnosis or treatment?From: Anatoli Garkusha (midilover@yahoo.com)Sun Feb 18 23:51:27 2001
Hello, Hear in Kiev one can meet the following variants of sonography in obgyn: 1. The gyn himself performs sono as part of his job and does not mention sono data in protocol. 2. The gyn perfoms sono as part of his job and gives a few words in medical card regarding his sono findings. 3. The gyn has no machine and refers his patients to other gyns with machine. 4. The gyn uses the services of a sonologist. Sonologist variants: 1. Only describes data - no conclusion. 2. Describes data and gives conclusion (resume, diagnosis). 3. Describes data, gives resume and writes down a few words of treatment he recommends (suggests). In order to cooperate with doctors I would visit them personally or call them up and clarify the volume of my participation in diagnostics. I would underline I never will allow myself intervene into the treatment tactics. Their patients return back to them no matter what my knowledge (snobbism) might whisper in my ear. Some doctors, though, ask me to suggest tactics. They say some words, like "operation recommended", "fibroid needs removal", "curettage ?", "gestagens for 4 months and repeated sonography" , - won't affect our cooperation. They may feel more confident to avoid operation (ovarian cysts, endometrial hyperplasia and so on) or insist on operation if the patient hesitates having heard other opinion from other consultants. (In this respect, what do you think about inserting some lines at the end of PROTOCOL, say CLINICAL IMPRESSION: ____________________________________ ? CLINICAL IMPRESSION: ____________________________________ or CLINICAL OPINION: ___________________________________________________________ ?) ___________________________________________________________ Some gyns used to refer their patients to other gyns with machines . They are sure that only gyn understands a gyn. They want another opinion. Other gynecologists get angry to come to know the sonologist wrote treatment or talked on treatment during the sonographical investigation. I agree that we must avoid mentioning the treatment issue. Any word we say is information the patient places very deeply into memory and psyche. The patient is made such. He uses the doctor's snobbism subconsciously. Some patients believe sonography sees all. Others, who come in line of paid investigation, are eager "to squeeze" all out of sonologist (sonographer), also information in words, not only sonographical protocol. And JUST AT THIS MOMENT we can forget deontology and start talking too much. These take your time, energy and "positrons" - and only then the patient is satisfied and leaves the lab.
-- Anatoli I. Garkusha, MD, sonologist. Kiev, Ukraine.
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