Re: Nuchal Cord
From: Philippe Jeanty (jeanty@TheFetus.net)
Sun Feb 22 07:49:19 2004
Well Alain, this is what we do and this is probably quite typical. The
patient is first scanned by one of our sonographer who obtains all the
biometry and images we require in our protocol. She also search for any
additional finding that might be relevant to the case.
She then present me a summary of the findings. I rescan the patient and
discuss with the patient the findings, while she prepares the report. Then I
review the report and finalize it and immediately send it to the referring
MD or give it to the patient to take with her if she so with.
I say "She" for the sonographer since they are all women, since we do just
on-gyn ultrasound and having a male sonographer who require a chaperon. But
a very similar scenario would occur with male sonographer in a practice that
does abdomen, thyroid and vascular.
Congratulations on obtaining your ECFMG this was a lot of work. Feel free to
contact me outside the listserv if you need more info (Jeanty@thefetus.net)
-----Original Message-----
From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
Szyller
Sent: Sunday, February 22, 2004 5:18 AM
To: Multiple recipients of list ULTRASOUND
Subject: Re: Nuchal Cord
Hi,
I am interested knowing how MD specialized in obgyn ultrasounds work in
the US, between having sonographers as" eyes" and not managing the patients.
(I am a french obgyn and my activity is getting overtime focused on
ultrasounds, I have lately received my ECFMG certification and I know
try to find a position for my training in the US )
Sincerely yours
Alain H.Szyller, MD
Philippe Jeanty wrote:
>This is an excellent point that I realized I had not touched. Telling
>findings is very different from offering opinions about management ! That
is
>a sure way to get into conflicts. When the patient presses me to tell her
>management options:
>1) I just provide broad information
>2) I tell her that I am not qualified to make that decision
>3) that her referring MD has a much more complete picture of her situation
>and that together they will explore the best approach in HER case.
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of laure
>Sent: Saturday, February 21, 2004 4:28 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>Hi,
>
>I am a obgyn physician from Spain. The figure of sonographers don´t exist
>here, but more or less is the same whe you make an eco for another
>physician. I allways say to my patients all I´ve seen, with my personal
>opinion of its meaning and prognosis. In case of other physician´s
patients,
>I never tell her nothing about management, just what I´ve seen, because I
>don´t know what is the intention of others.
>In a nuchal cord, I just invite my patients to make a cardiotocographer
>register at the begining of labor, instead of wait till clear labor
>condition.
>As the saying goes; by the mouth, dies the fish. Most of the litigations
>begin with two diferents opinions.
>
>L. Folgar
>County Area Specialist obgyn physician
>Melilla
>Spain
>
>-----Mensaje original-----
>De: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net]En nombre de Sue
>Davies
>Enviado el: Sábado, 21 de Febrero de 2004 04:30 a.m.
>Para: Multiple recipients of list ULTRASOUND
>Asunto: RE: Nuchal Cord
>
>Sorry Terry, I read my emails back to front!!
>I believe that sonographers who are well trained make these sorts of
>descisions all the time. The central issue here is TEAM WORK - if
physicians
>and sonographers work as a team then there is rarely any difficulty. We,
>like Dr. Jeanty's team, know what our colleagues expect and how they
usually
>deal with many situations and behave accordingly. For the case in point, if
>I saw a cord draped over the babies shoulder, I would make no comment -
>since that is the policy our team has decided upon. If the cord is wrapped
>tightly or more than twice - then we comment. Once again, I believe that
the
>physician who started this discussion should talk to the sonographer or
>radiology department involved and resort to some team work.
>
>Cheers
>
> Sue Davies
>Program Director
>PO Box 434
>Mermaid Beach, Q, 4218
>tel: (07) 5526-6655
>http://www.aiu.edu.au
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>DuBose, Terry
>Sent: Saturday, 21 February 2004 12:08 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>Sue, what you say is true. However, it still does not answer the question
>of what a sonographer should do when they observe a nuchal cord, which is
>just across the fetal shoulder and not wrapped tightly
>around the neck or 2-3 loops around the neck.
>
>As I understood the original question, the physician did not think it was
>important and did not want the sonographer to draw attention to the nuchal
>cord (comment or record images) because the physician then felt
>obligated to comment in the report. I have worked with physicians who
>also did not want incidental findings recorded because they then felt
>obligated to comment.
>
>So the question remains, should the sonographer ignore conditions which
they
>believe are insignificant or not, or should they give all information to
the
>physician and let her/him make the decision?
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
>Assistant Professor & Director
>Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP
>4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA
>501-686-6510
>DuBoseTerryJ@UAMS.edu
>http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Sue
>Davies
>Sent: Thursday, February 19, 2004 8:07 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>I agree Terry, that is why referring physicians should discuss such things
>with both the radiologists and the sonographers in their area so that all
>are aware of what is considered best for their particular needs.
>
>Cheers
>
> Sue Davies
>Program Director
>PO Box 434
>Mermaid Beach, Q, 4218
>tel: (07) 5526-6655
>http://www.aiu.edu.au
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>DuBose, Terry
>Sent: Friday, 20 February 2004 10:44 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: RE: Nuchal Cord
>
>As I understood the original question, it was not the sonographer telling
>the patient about the cord, but the physician did not want to know if the
>cord was just draped over the fetal shoulder, with a film showing this,
>because the physician then felt obligated to comment in the report about in
>case there was a poor outcome.
>
>So should the sonographer take a picture of a nuchal cord that does not
>encircle the neck two or more times? Or ignore it... that is the
>question, as I understand it.
>
>Sonographers are expected to take diagnostic images, but not considered a
>diagnostician, even though their credential is "Registered Diagnostic
>Medical Sonographer". They are between a rock and a hard place with many
>physicians.
>
>Peace, Terry J. DuBose, M.S. RDMS
>Little Rock, Arkansas
>
>------------------------------------
> I absolutely agree......why is a sonographer telling the patient about
>------------------------------------
>the cord? Perhaps a policy should be put in place that the sonographer
>------------------------------------
>tells the doc about the cord, then leaves it up to the doc to tell the pt.
>
>Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
>
>Assistant Professor & Director
>Diagnostic Medical Sonography Program
>University of Arkansas for Medical Sciences, CHRP
>4301 West Markham St. Mail Slot #563
>Little Rock, Arkansas, 72205 USA
>501-686-6510
>DuBoseTerryJ@UAMS.edu
>http://www.io.com/~dubose/
>http://www.uams.edu/chrp/dms/default.asp
>http://www.obgyn.net/us/panel/panel.htm
>---------------------------------------------------------------
>
>---------------------------------------------------------------
>-----Original Message-----
>---------------------------------------------------------------
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>Ilvlucy@aol.com
>Sent: Thursday, February 19, 2004 5:19 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Nuchal Cord
>
>In a message dated 2/19/2004 4:28:18 PM Central Standard Time,
>sue@aiu.edu.au writes:
>
> If I could buy into this one - surely a sonographer is duty bound to
>examine
> the fetus in all its aspects and document the findings. We routinely
>include
> cord examination in third trimester scans, it is the obstetrician's
>duty to
> discuss the results with the patient and make decisions on
>management, if a
> sonographer finds a nuchal cord wrapped securely (3 or 4 times
> circumferentially) and does not report this, they would be liable
>for
> censure if anything went wrong. Maybe the best outcome for your
>current
> difficulty would come from the referring physicians having a
>discussion with
> the sonographer in question and make them aware of their cocerns
>
> Cheers
>
> I absolutely agree......why is a sonographer telling the patient about
>the cord? Perhaps a policy should be put in place that the sonographer
>tells the doc about the cord, then leaves it up to the doc to tell the pt.
>
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