Peace, Terry J. DuBose, M.S., RDMS
--
I am Nora Carroll R.D.M.S., R.V.T. I have worked in several
situations over the years in the Southeast U.S. I thought I would share how
I dealt with this difficult aspect of ultrasound.
I explain to all my patients before I start that I want to take a
minute to look at everything closely before we talk about it or look at the
screen together. If they press for information during "my" minute; I assure
them that they will know something before they leave that day.
If I find absence of fetal heart motion, I document all of the
required images for the exam. Near the end of this time, it sometimes
becomes evident that there is a problem. At this time I tell the patient
the truth. "I'm sorry, I'm not seeing heart motion (or there may be a
problem with the baby's ______). BUT if you'll excuse me a moment I'll step
out and get your doctor to come in and we'll look at everything together."
I also defer any medical questions at that time. I then get the referring
OB/GYN, radiologist, etc. and family member or friend that may have
accompanied the patient. (most places I go let family members come in at the
beginning) Together we show the patient the screen while their doctor/other
explains to them what may/may not have happened. There is always an image
for her at the end of the exam or in her chart. It could be the only
picture of a child of hers she ever has. I think the patient doesn't feel
she has had information withheld from her; but also has a seed of doubt
planted that this isn't a "normal" ultrasound exam.
There have been situations when no matter what was done or how the
case was handled; is turned into a train wreck from beginning to end. There
are other factors that could be effected such as exam room time; pt
scheduling; availability of doctors, etc. The view of most all the
practices I have worked for has been that the patient takes PRIORITY over
these other circumstances. The individual is given the best care, as well as
the time and attention needed; especially during this life altering event. I
have worked in private practice, hospital radiology, maternal fetal medicine
and mobile practice at multiple sites. Overall, the referring physicians
and radiologists have been supportive. Their patient's worse moment
involving the pregnancy didn't necessarily involve the ultrasound exam.
I understand there are restrictions placed on the sonographers role
in dealing with this matter. I also understand that sometimes you have to
be willing to step out and take what may be more responsibility than is
outlined in the job description. I don't know if this is a measure of
experience or familiarity with the interpreting physicians. I've never felt
that I was second guessing a doctor. If I didn't know the answer, I said
"I'm sorry I'm not the one to answer that for you." or "I don't know".
I hope this helps those dealing with these patients. They are the
reason we're in this field. I also do not wish to attract flames.
Oh and Mr. Whelan, Good luck with your pregnancy. May you continue
to bond via ultrasound. :)
Thanks
Nora Carroll R.D.M.S., R.V.T.
