Re: Non-Diagnostic Use of Ultrasound
From: art fougner, md (evsono@pipeline.com)
Tue Aug 6 07:20:41 2002
of course much of ob sonography IS entertainment sonography - we talk to
the patient - show them structures, anatomy, give them pictures, etc.
the difference for our practice is that WE actually look for deviations
from the norm and have to deal with the vagaries of reimbursement. THEY
oth get paid in full for what most of us would consider a substandard
exam.
just my opinion - i could be wrong.
art
At Mon, 5 Aug 2002, Terry J DuBose wrote:
>
>Dr. Deigan, what you say is true, but much is not emphasized enough.
>Your sentence is a large part of it:
>
>"Of course far more preferable would be to have "entertainment"
>ultrasound scans also done by competent sonographers, than pushed
>underground to be done by less competent people."
>
>Not only is "entertainment" sonography not being pushed underground, some
>of these folks have been quoted in the Wall Street Journal. "This isn't
>for medical diagnosis. I don't care if I see three legs, I will only
>point out two." It just gives the profession a bad name.
>
>Also, physicians can take a much lighter attitude toward the business
>because they have a license to virtually do anything with sonography,
>whether they really have a clue about sonography or not. Yet, a skilled
>sonographer is open to being challenged for practicing medicine without a
>license if they do the same thing.
>
>These issues, plus the reality that a profession that I have truly loved
>since 1976 and gives me a feeling of contributing to society is being
>abused, just does not set well with me... and many.
>
>Much of what you say is true. And I think if there were any kind of
>assurance that those using sonography had the appropriate education and
>skill to recognize a fetal anomaly, then probably there would be much
>less of an uproar. Unfortunately, there seems to be no one who can make
>that assurance.
>
>P.S. If any of you catch the ICU special this Wednesday on ABC, it was
>filmed at Arkansas Children's Hospital here in Little Rock. ACH is one
>of our DMS Program's clinical education sites, and Dr. Renee Bornemeier,
>a skilled pediatric and fetal echocardiologist is featured. Dr.
>Bornemeier and Lori Heil, RDMS are a great team, who lecture and work
>with our students. They also do the fetal echo clinic at the UAMS
>High-Risk OB Clinic.
>
>Peace, Terry J DuBose, M.S., RDMS, FSDMS, FAIUM
>University of Arkansas for Medical Sciences
>Little Rock, Arkansas USA
>
>On Fri, 2 Aug 2002 12:55:46 -0500 "Dr. Eric Deigan"
><ericdeigan@prodigy.net> writes:
>> I'd like to put in my two cents worth on this topic. I have always
>> had
>> trouble understanding the vehemence with which some people oppose
>> "entertainment" ultrasounds. I certainly have trouble seeing it as
>> a
>> "crime". Given our present state of knowledge of the dangers of
>> ultrasound
>> from diagnostic machines, I would think that there are many far
>> more
>> potentially risky things that pregnant women do during their
>> pregnancy (like
>> driving their car, going up and down stairs, ingesting medications
>> of
>> uncertain safety in pregnancy, let alone things like smoking and so
>> on) than
>> having an extra ultrasound scan or two.
>>
>> So called entertainment ultrasound scans I think still may have
>> great value
>> to the patient and her partner and family, by creating better
>> bonding and
>> more interest and excitement about the pregnancy.
>>
>> While I am a strong believer in there being a great value of
>> diagnostic
>> ultrasound in pregnancy, in the vast majority of prenatal ultrasound
>> scans
>> we are not going to find anything that will significantly impact
>> the
>> management of the pregnancy. Sure there is reassurance for the
>> parents and
>> the physician that all is normal. But how much more valuable can we
>> say
>> that psychological reassurance is, than the psychological benefit of
>> the
>> parents seeing their baby one extra time or in a more realistic (3-D
>> / 4-D)
>> way. It's a little paternalistic of us to make decisions for our
>> patients
>> as to what they can or can't have or do. We can advise them
>> against
>> something, but most things aren't (or shouldn't be) outlawed unless
>> they are
>> truly dangerous to society. And how many of us in the profession
>> haven't
>> scanned our partners or ourselves or our friends to let them see the
>> baby an
>> extra time?
>>
>> As a profession I would like to see all diagnostic ultrasound be
>> performed
>> by competent sonographers and sonologists, which leaves me far more
>> concerned about the many people performing supposedly diagnostic
>> ultrasound
>> scans who have limited training and expertise in doing so, and
>> therefore
>> miss important information that they are supposed to be getting,
>> than I
>> would be about someone doing a scan who at least admits the scan may
>> not be
>> diagnostic of all anomalies (which of course no scan is).
>>
>> Of course far more preferable would be to have "entertainment"
>> ultrasound
>> scans also done by competent sonographers, than pushed underground
>> to be
>> done by less competent people. Perhaps we should think of it like
>> prohibition or abortion... we may not like people using or abusing
>> alcohol
>> or doing abortions, but they'll probably still be provided by
>> someone in
>> society if it isn't offered legitimately, and so isn't it better
>> overall to
>> have it offered under more controlled or competent circumstances?
>>
>> I am an OB/Gyn - MFM and have been involved with performing
>> ultrasound for
>> 26 years. My current practice is restricted to diagnostic
>> ultrasound and
>> related consultations in OB and Gyn. In addition to having two ATL
>> 5000
>> machines, I also have a Medison (now being put out by GE) 730 4-D
>> machine,
>> which I have had for almost a year. Right now the 3-D/4-D aspect of
>> the
>> machine gets relatively little use, because I have not been offering
>> it to
>> patients for entertainment on a paying basis, but have been using it
>> in
>> situations where I see potential for clinical benefit, and
>> occasionally
>> offering the 3-D / 4-D to patients for free if I have a little extra
>> time at
>> the end of a visit. I'm busy enough that I don't have the time to
>> offer and
>> market entertainment ultrasound for payment, but in a free society
>> I
>> personally don't think it is right that patients cannot choose to
>> have it
>> done, or that I would not be allowed to offer it if I wanted to.
>> The
>> president of First Look Sonograms recently sent in quite an angry
>> letter to
>> this forum. While I thought the way the letter was written was
>> inappropriate, I can empathize a little with someone feeling
>> attacked for
>> offering something that they truly believe is a valuable (in the
>> minds of
>> his clients, if not necessarily a medically diagnostic) service.
>>
>> I'd be interested in feedback on my thoughts about this.
>>
>> Eric Deigan, M.D., FACOG, FRCSC
>> Carolina OB/Gyn Ultrasound Center
>> Carolina Perinatal Associates, PLLC
>> Cary, NC, USA
>>
>> -----Original Message-----
>> Date: Wed, 31 Jul 2002 13:14:28 -0500 (CDT)
>> From: kroersmardms@netscape.net (Karen Roersma)
>> To: ULTRASOUND@OBGYN.NET
>> Subject: Re: Non-Diagnostic Use of Ultrasound
>> Message-ID: <200207311814.g6VIESu20851@mail.medispecialty.com>
>>
>> Dr. Fougner,
>> You've hit the nail on the head! Sonographers involved in this type
>> of
>> practice, either as employees or as owners of "keepsake" ultrasound
>> businesses should be subject to disciplinary action by the ARDMS
>> and
>> SDMS, with membership revoked.
>> I'll be interested to see what happens.
>> ~Karen Roersma, RDMS
>>
>> At Wed, 31 Jul 2002, art fougner, md wrote:
>> >
>> >now that you have defined the "crime", where's the punishment?
>> i've
>> >noticed a few of these places involve members of SDMS and in one
>> case,
>> >an MFM.
>> >
>> >art
>>
--
art fougner, md
ich bin ein New Yorker
