ULTRASOUND Messages for December, 2002: Re: "visualized", Downs and hearts

Re: "visualized", Downs and hearts

From: James S Smeltzer MD

gaperina@mindspring.com

Sat Dec 7 22:18:58 2002

a pleasant day in May, you are on your back in a field with your eyes closed and the sun on your face... Insects are buzzing about.... in the distance is a small dark man.... He is shouting.... You reluctantly get up and leave your repose and walk toward him... You draw closer.... Finally you hear him:

"VISUALIZE IS A SYNONYM FOR IMAGINE!!! DUH!"

I personally would not hire a sonographer who did much visualizing during her exam - it implies sophistocation that is not present. It alludes to inferences of erudition, and implications of normality, when all it says is that you made it up in your mind. It takes attention from what is Seen. Seen, now there is a good word. It is short. It is clear. It implies nothing other than what it says. It means you looked. It means you thought about it. That is the standard. It is a good standard.

If I were a juror I would make the guy who was busy visualizing when he should have been looking pay through the nose if he missed anything because his report says he was not doing what he should have been - looking.

I would have more mercy for the guy who looked and saw what he was supposed to but missed a problem. He is human. Stuff happens. This is life.

I saw my first big miss on a fetal echo yesterday - a large VSD that lacked a muscular septum and needed to be treated as a single ventricle. Most of the septum was there but didn't do anything. We had seen a few other stigmata of her Down Syndrome but the parents declined amnio. She is so beautiful and cute and charming despite her two heart surgeries in her short life. Having a little difficulty adjusting to the new baby - two year olds are like that. If you ever have a patient who is considering options after prenatal diagnosis of Down Syndrome, and wants to talk to a Mom who is going through raising one call me at 4043183451 24/7 for her number. She is happy to do so. Jim

Jim Smeltzer

At 04:10 PM 7/24/2000 -0800, you wrote: >From your message I get the impression that you may be in one of those
>practices where the doctor not only does not always initial YOUR report, but
>does not look at the images that you take. (There are lots of those
>practices, I think, and they make an excellent arguement for the sonographer
>being paid as the professional she or he is. But that is another subject).
>
>If your doctor does not really do the report at all, but you really do it
>and it is offered as the doctor's work, I suspect that legally it does not
>matter what kind of report you use, your practice is at risk. (I do not mean
>that you do not know what you are doing - in many such practices I am sure
>the sonographer knows MORE about prenatal sonography than the doctor).
>
>I use a DOS computer program called BABE and I am very happy with it. I wish
>the vendor would come along with the Windows version which he has been
>working on for years. I paid $1800.00 for it about 7 or 8 years ago.
>
>I guess the problem with saying "visualized" is that that does not mean
>normal. Perhaps if you changed "visualized" to "seen and appears normal"
>that would be a little better. I doubt that a handwritten report is bad,
>providing your handwriting is legible. But I am always proud of the
>appearance of my computer-generated reports. I suppose a clever lawyer could
>make a lay jury feel either way about it: a handwritten report is better,
>indicates more personal involvement, more care, than a computer printout, or
>just the opposite, depending on what the lawyer wants the jury to believe.
>
>Joseph A Worrall MD RDMS
>

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