Re: "visualized", Downs and hearts
From: Dave Berck (djberck@yahoo.com)
Mon Dec 9 08:12:40 2002
As an aside, BABE is about to come out with a windows
version that is HIPPA compliant. O yeah -- get ready
to pony up about $5k.
--- James S Smeltzer MD <gaperina@mindspring.com>
wrote:
> Visualize....
>
> 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
> >
=====
David J. Berck, MD, MPH
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