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To tell or not to tell.From: Karen Robertson (RobertsK@HWL.CO.NZ)Tue Jan 19 18:42:33 1999
Diana, You wrote:"But my question is, how does this information change the management of the pregnancy? This knowledge does not change the outcome at all." This discussion brings out two point: 1) What findings alter the management of the pregnancy? 2) How much do you tell the patient? 1) A number of ultrasound findings are routinely noted, but do not influence the management of pregnancy at all. This particularly pertains to borderline findings and "soft signs". Does the patient have the right to know these findings are there and what they mean? I think so, even if the finding is borderline and will need follow-up. This pertains to a variety of things such as: CPC's, small subchorionic hemorrhages, marginal placentas, two vessel cords, isolated club-foot, borderline ventriculomegaly, and many others. In fact, only a miniscule fraction of pregnancies will have altered management following an ultrasound whether normal or not. 2) How much you tell the patient is a topic of a continuous and hot debate. It largely depends on your workplace, your comfort level in disclosing information, local regulations, and many other factors. In our workplace, we feel it quite appropriate to give patient some indication of what their ultrasound shows before they leave the department. Of course, we do not provide "counseling" per se; we leave that to the perinatal specialists. But I think it is important to establish a positive rapport with the patient, answer their questions, and give them some information about the ultrasound findings. It is precisely this patient interaction that distinguishes a sonographer from radiographers, etc. as has been discussed on this forum many times before. Of course, I do not expect agreement on this from everybody. There are those sonographers who religiously stick to the policy of saing nothing and referring the patient to a radiologist if they want to ask any questions. There are those who work in small community hospitals in the middle of nowwhere and routinely report their findings in the chart before discussing it with a radiologist next week. Most of us are somewhere in the middle of this spectrum. I doubt that one can find "right" and "wrong" here. To me, it's a difference of individual circumstances, and your personal opinion. Many Regards, Martin Necas.
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