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Re: Nuchal CordFrom: Terry J DuBose (tjdubose@juno.com)Sun Feb 22 09:10:21 2004
This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. ----__JNP_000_58a6.591a.54c0 Content-Type: text/plain; charset=iso-8859-1 Content-Transfer-Encoding: 8bit "But a very similar scenario would occur with male sonographer in a practice that does abdomen, thyroid and vascular." I would like to point out that this is also the way it works in most laboratories with male sonographers performing OB/GYN and Breast exams, with a chaperone, of course. Terry J. DuBose
On Sun, 22 Feb 2004 08:51:01 -0600 "Philippe Jeanty"
<jeanty@TheFetus.net> writes:
> Well Alain, this is what we do and this is probably quite typical. <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> "But a very similar scenario would occur with male sonographer in a
practice that does abdomen, thyroid and vascular."
I would like to point out that this is also the way it works in most
laboratories with male sonographers performing OB/GYN and Breast exams,
with a chaperone, of course. Terry J. DuBose
On Sun, 22 Feb 2004 08:51:01 -0600 "Philippe Jeanty" <jeanty@TheFetus.net> writes:
> 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 > >--------------------------------------------------------------- >=20 >--------------------------------------------------------------- >> > > > >-----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=20 >------------------------------------ > > I agree......why is a sonographer telling the patient > about >= >------------------------------------ > > I >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 > >--------------------------------------------------------------- >=20 >--------------------------------------------------------------- >> > >-----Original Message----- > >From: > 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. > > > > > > > >Confidentiality Notice: This e-mail message, including any > attachments, is > >for the sole use of the intended recipient(s) and may contain > confidential > >and privileged information. Any unauthorized review, use, > disclosure or > >distribution is prohibited. If you are not the intended recipient, > please > >contact the sender by reply e-mail and destroy all copies of the > original > >message. > > > > > >--- > >Incoming mail is certified Virus Free. > >Checked by AVG anti-virus system (http://www.grisoft.com). > >Version: 6.0.592 / Virus Database: 375 - Release Date: 18/02/2004 > > > > > >--- > >Outgoing mail is certified Virus Free. > >Checked by AVG anti-virus system (http://www.grisoft.com). > >Version: 6.0.592 / Virus Database: 375 - Release Date: 18/02/2004 > > > > > > > > > > > >--- > >Incoming mail is certified Virus Free. > >Checked by AVG anti-virus system (http://www.grisoft.com). > >Version: 6.0.593 / Virus Database: 376 - Release Date: 20/02/2004 > > > > > >--- > >Outgoing mail is certified Virus Free. > >Checked by AVG anti-virus system (http://www.grisoft.com). > >Version: 6.0.593 / Virus Database: 376 - Release Date: 20/02/2004 > > > > > > > > > > > > > > > > > >
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