Re: Ultrasound--diagnosis or treatment?
From: Anatoli Garkusha (midilover@yahoo.com)
Mon Feb 19 12:55:12 2001
Dear Naseem,
Of course I agree with you on either point.
These matters: here they are in full spontaneity and probably require the
same if not larger attention.
No enveloped protocole from my side.
It is given to the patient straight away open to read ( and as I frequently
see, my paper being scrutinised by the woman just having left my office),
only oncological cases are informed otherwise about.
Perhaps it is mine and my colleagues's here big mistake that we would
dictate sonographical data just during the very investigation and the
patient hears every word of it.
Them comes resume (my Diagnosis) at the end of the document and some words
are told to the patient about findings.
I used to emphasize to the patient that what I wrote is for the doctor to
judge. But in a few words I found this and that, that only the gynecologist
can propperly place my results into the whole picture, all what other
colleagues of the Forum have opined already.
I found out that nowadays each gynecologist has already formed links with
sonologists of his liking...
Someone prefers a yielding diagnostician, who tries to accompany him and
would not say his
categorical incompliance. I met sonologists of this category mostly among
other gynecologists
mainly because these are kept bound either by their old clinical knowledge
and resist asuming
sonographical modern progress ... or bound by fraternal cooperation...
Less often and not that readily will a gynecologist deal with a sure and
indipendent sonologist
(sonographer) who claimes he sees more inside the pelvis, or more to it, he
forgets his role and
turns brave enough to say the gynecologist has no need to palpate a waman,
let him care for
external genitals, colpos, neck and pregnancy...
There are sonographers and sonologists situated within the range. Naturally
all very different in
education, radiological background, experience... And also, like me, seeking
for a good gynecologists to work with, to gain experience from him and show
him my acheavements...
I gather every gynecologist, who has to use sonographical data in his
diagnosis, is to
select a sonography guy best to his wishes. He must have opportunity to test
him, know
exactness of his resumes and feel respect to him. He must meet him from time
to time and discuss interesting cases like we do in the Net. Both needing
each other with the same target of
doing best to the patient and at the same time enjoing each other's company.
Regards,
Anatoli
>----- Original Message -----
From: "Dr.Naseem Ahmad" <dr_naseemahmad@yahoo.com>
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@mail.medispecialty.com>
Sent: Monday, February 19, 2001 4:48 PM
Subject: Re: Ultrasound--diagnosis or treatment?
> 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.
> >
>> >----- Original Message -----
> >From: "Dr.Naseem Ahmad" <dr_naseemahmad@yahoo.com>
> >To: "Multiple recipients of list ULTRASOUND"
> ><ultrasound@mail.medispecialty.com>
> >Sent: Sunday, February 18, 2001 10:02 PM
> >Subject: Re: Ultrasound--diagnosis or treatment?
> >
>> >> >----- Original Message -----
> >> >From: Naseem Ahmad <dr_naseemahmad@yahoo.com>
> >> >To: Multiple recipients of list ULTRASOUND
<ultrasound@forum.obgyn.net>
> >> >Sent: Friday, February 16, 2001 17:33
> >> >Subject: Ultrasound--diagnosis or treatment?
> >> >
> >> >> I am a practising gynaecologist in Karachi. We send
> >> >> patients for ultrasonography for various reasons. Nine
> >> >> out of ten sonologists after giving their report
> >> >> prescribe some sort of treatment/management. For
> >> >> instance a patient sent for follicle study comes back
> >> >> with the remark: hcg today and intercourse tomorrow
> >> >> without knowing what the treating physician has in his
> >> >> mind. The other common example: Ovarian cyst, advised
> >> >> ca125 or ovariectomy or cystectomy not advised.
> >> >> Fibroid uterus: suggest GnRH agonists or myomectomy
> >> >> advised. And there are hundreds of examples that not
> >> >> only disturb the anxious patients but create a great
> >> >> degree of conflict between the patient and her
> >> >> physician as she comes back with the diagnosis and
> >> >> ultimate treatment which in majority of patients is
> >> >> not indicated. I have verbally spoken to several
> >> >> sonologists , written about it in the medical press
> >> >> but this practice continues abated. Any comments.
> >> >> Dr. Naseem Ahmad FRCOG
> >> >> Chief editor "The Gynaecologist" Quarterly
> >> >> Karachi, Pakistan
> >> >>
> >
