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Re: "patient seeing exam"From: T whelan (twhelan3@mail.bayou.com)Thu Aug 27 16:53:29 1998
Spnglr@aol.com wrote:
> In a message dated 98-08-26 19:22:09 EDT, you write: Hi folks... Nancy and Terry, Sorry, but I strongly disagree, with respect for both of you I consider friends! Though I am in favor of Sonography as an independent profession, it is not here yet. First off: Where in the Sonographers "Scope of Practice"...is it specifically stated that the Sonographer is mandated to inform the patient of disease processes, (including foetal demise...etc) with out consult with the reffering/interpreting Physician? (I assume this by the post) Where is it written that we are reacquired to do as the employer asks if it is not in our job description, or scope of practice? Forgive me if I missed an important paragraph in the "Scope of Practice". I would have to have an extremely intimate working relationship with the Radiologist/interpreter to make that speech to the patient. If my employer were to hear of me doing such as this, I would hover like a fly, waiting for a windshield on a fast free-way! This is not to discount my ability to interpret disease. Call me conservative, but I stand by this, and will continue until, I have an M.D. behind my name (and the liability insurance in my name...not a Hospital or corporate policy), or...the Sonographer is granted professional status (it will come), with both the rewards, and responsibilities associated with transcendence. This is a difficult letter for me to write, because I am basically in favor of the responsibilities we are discussing( You know that!!) I am not suicidal though, I have a few more years left to work. We are not there yet, and we should not usurp responsibilities that Federal, and State law have spelled out to date. When informing a patient of foetal demise, or any other abnormality without the prior knowledge (specific to the patient in question) of the referring Physician or interpreting Physician, it is a violation of Federal law, and Scope of Practice. I say this assuming that the interpreting/referring Physician has not been notified prior to the utterances of the Sonographer to the Patient. That, friends is making a diagnosis, and practicing medicine without a license. If you want to flame me, then please remember that this discussion revolves around a specific point: informing the patient of foetal demise before leaving the room. It is assumed that NO contact is made with the outside world. In my practice, I have had to deal with many situations as such. My protocol is to be VERY polite to the patient. I only turn the monitor toward the patient when I am satisfied that most everything is in order. If there is a fatal problem, I politely leave the room, and inform the Interpreting/referring Physician. I always accompany the Physician when it is time to talk. In those few times where I was the one to spill the news, I have always had another licensed employee of the institution present with me when I talk with the patient and family. ( I am a Mobile Sonographer..) Yes, I have been there, and will be there again. And...yes, we Sonographers are part of the grieving support team. I am not trying to dump upon others the fear, and pain that comes with these discussions. I am pointing out the fact that many people become very litigious when faced with something as devastating as fatal or serious foetal abnormalities. One should not be in a room alone with the patient and family members when discussing these issues. That is common sense, and it is part of the caring team spirit. Medicine is a team effort . Nancy, I agree that the U/S suite is the place to "toot" our horn, and I DO! I just think there are limits... I have to disagree regarding the issue you brought up about folks not knowing what they are seeing (politely though! :) Many of my patients know what an "arm"..or the "head" is.. they are also VERY aware of foetal motion... (..is the baby moving?? is that the baby?? why don't I see it move???) That is why I look first, and share later...which I do!!!!!!!! and we have a ball!! My wife and I shared the FIRST images of our first pregnancy last night! We spent about 45 minutes looking and laughing! Ladies truly bond with the U/S experience! So did I...DUH! I also found an abnormality last night...Placenta Previa (complete). So life is a challenge, and I will deal with it. In parting...I have spent the better part of 2 hours writing this.. I do hope that I have not started a mess... I am an older bird, but I still have most of my feathers because I don't fly when lightning is striking, but I love the smell of ozone. Sincerely, My the Lord bless us all..... Tom Whelan R.D.M.S., R.D.C.S., R.V.T. and darned proud of it!
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