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Re: Ultrasound--diagnosis or treatment?From: Dr.Naseem Ahmad (dr_naseemahmad@yahoo.com)Mon Feb 19 07:46:09 2001
Thank you Dr Garkusha for your reply. You will agree that some sonologists may be very clever while others may not be so clever. Similarly some may have had ample obgyn training while others may not have had so ample training. So opinions may differ and their accuracy (ragardless of the ethical stand point) may vary. You are right when you say that patients tend to place their trust more in a sonologist who seems to have penetrated the patients abdomen and discovered everything, hence they would like to pay more attention. Whether a gyn does his own sono or not , the standard procedure should be that the sonologist superficially explains the visible findings to the anxious patient, writes down the report , seals the envelope and sends the patient back to the referring doctor. It will be a great shame if a gyn uses the inflence of a sonologist to prepare the patient into accepting the line of treatment.In a society where women are not necessarily educated and intelligent and are too anxious, a remark from a sonolgist about ,say possible myomectomy, while in fact the fibroma may not be having any adverse effect on fertility, will send the vulnerable patient into fits. This definitely is not called for. As far as the question of "clinical impression" is concerned there is no harm as long as the impression revolves around the diiagnosis and not the treatment. To end, a less dicerning sonolgist may conclude his or her report on a menopausal woman with 3 cms large ovaries as "normal pelvic findings" may do a great harm to the woman who would believe that all is well and probably not even bother to report back to the gyn and may well be heading towrds malignancy. The moral of the story is : measure the ovaries and descreibe the echogenecity or its absence and send the report to the gyn who may proceed with further line of management. This was just an example. Regrds Naseem Ahmad MD FRCOG > >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: ____________________________________ >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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