Re: sonographers right to give information to patient
From: James S Smeltzer MD (gaperina@mindspring.com)
Tue Mar 30 05:50:23 1999
Dear Stumped Sonographer,
Sounds like your MD is new, untrusting, insecure, recently sued and not
very familiar with SOP in US units. The references sited are a help. IMHO
there is no defense for that sonologist position unless s/he feels the need
to be there to do the narrative for the patient.
I will say this one more time. The content of the sonographic examination
is the property of the patient. I personally would not recommend my patient
visit such a lab, as they are obviously clueless or have incompetent
personnel. In keeping with that philosophy we tape on request and
sonographers say what they know, except for "painful" diagnoses. Due dates
are tricky. We have gotten around that with a standard set of questions
and algorithms that make the sonographers more consistant for clinical
dating than the midwives, IMHO.
In the long run, I recommend that you use sick/personal time to pursue
other potential opportunities for employment, as such a person is not
likely to be a good partner for work in many other respects Underline
RESPECTS. My 2C worth.
Jim Smeltzer, MD
At 01:56 PM 3/24/1999 -0600, you wrote:
> -----Original Message-----
> From: roger sanders [SMTP:sanders87529@yahoo.com]
> Sent: Wednesday, March 24, 1999 11:16 AM
> To: Multiple recipients of list
> Subject: sonographers right to give information to patient
>
> I just recieved this letter from a sonographer I trained. I am away
>from my files. Can anyone help?
>
> "today we were told by one of our Radiologists not to tell the
>patient the sex of the baby. And to keep our narrative while scanning the
>fetus VERY GENERIC. And we can't tell them how far along they are, even if
>the measurements are equal and they are intelligent people and they can read
>it on the screen, while we measure!!!. I am having heart failure, but
>keeping my cool. I have to present the sonographer's point of view at the
>next Radiologist QA meeting, so I need ammunition. If you could just steer
>me to the right journals for articles concerning the importance of the
>bonding between parents and fetus and maybe an article about the
>sonographer's role. I just haven't kept up with all the journals. Is there
>any way you could help me??"
>_________________________________________________________
>
>_________________________________________________________
>Dear Roger Sanders & students:
>
>There have been articles about parent-fetal bonding in the Journal of
>Diagnostic Medical Sonography (JDMS), unfortunately I don't recall the exact
>issues. Perhaps the Editor, Julia Drose can tell us the specific issues and
>authors.
>
>There are also other publications (many) concerning sonographer-patient
>interactions. This kind of argument drives me a little nuts. To not allow
>a trained, experienced sonographer to say anything to the patient does not
>enhance the patient's confidence in the examination they expect and for
>which they have paid.
>
>In a chapter on Ethics, William Meacham, Ph.D. states in part:
>
>"QUALITY OF FEEDBACK DURING THE EXAMINATION"
>
>"Regardless of whether it is done as part of routine prenatal care or only
>in selected circumstances, there appears to be little doubt of the benefit
>of good quality feedback to the woman during the examination. A number of
>studies have revealed that showing the woman the image and giving her a
>running commentary about it is good for both mother and child. Giving lots
>of feedback reduces maternal anxiety and produces more pleasant emotional
>experiences than hiding the image and giving only a summary after the
>exam.... The babies whose mothers had received lots of feedback in these
>studies were born with fewer complications, had greater birth weight and
>were less irritable after birth than those whose mothers had received only
>summary information. "
>
>"This is to be expected. We are curious and intelligent beings. It's in
>our nature to want to know what's going on around us. Satisfying this
>curiosity fulfills our nature; restricting information frustrates it,
>resulting in more anxiety and stress."
>
>Dr. Meacham continues:
>
>"How much should the sonographer tell the patient? The sonographer is, by
>and large, not a licensed physician and is not qualified to make [issue]
>medical diagnoses. But he or she must have enough knowledge to know whether
>a scan is good or not and will certainly have acquired a working recognition
>of normal anatomy and the various abnormalities."
>
>"The benefits of sharing information with the mother and family are
>numerous. Doing so is rewarding; it increases recognition of one's
>connectedness with them as human beings. It also mitigates the potential
>ill effects of relying on electronic techniques instead of human intuition,
>as discussed above. Sharing knowledge treats the woman as a person and not
>merely an object to be scanned."
>
>Dr. Meacham concludes a subsection with:
>
>"It is unfortunate that sonographers and MDs see themselves, at times, as
>adversaries. The best approach would be to view each other as partners,
>each bringing a particular expertise to the task of providing good medical
>care for the woman and her baby."
>
>>From Meacham W. in: DuBose TJ: FETAL SONOGRAPHY, W. B. Saunders, 1996, p.
>85-87.
>
>Also the following.
>
>Dr. Ken Taylor, Yale University, addressed this question in the Nov/Dec.,
>1982, issue of the SDMS Newsletter. His own words are clear and concise:
>
>".... There is a very important difference between sonographers and other
>imaging technologists. Other technologists may reject an image because of
>sub-optimal technical quality, but the sonographer usually rejects over 95%
>of the scans because they do not provide the diagnosis. The sonographer
>must make the diagnosis and be able to interpret the scan to document the
>presence of any abnormalities. This is the unique responsibility of the
>sonographer."
>
>It is my opinion that we are Diagnostic Sonographers, and as Dr. Taylor has
>stated, we must make the diagnosis, this does not mean that we issue the
>report, prescribe the medications or therapy, or do the surgery. But we do
>MAKE the diagnosis. Now the problem of telling the patient specific
>pathologic information does appear to fall into the realm of practicing
>medicine, but to not be able to talk to our patients treats us and them as
>less than human, as Dr. Meacham states above. The line between being human
>to our patient and practicing medicine is a bit fuzzy, and it does take some
>judgement on the part of the sonographer to know when the line is near...
>but that is why we are Diagnostic Sonographers and not Techs.
>
>For more reading see:
>
>. James A E, Bundy A L, Fleischer A C, et al; "Legal Aspects of Diagnostic
>Sonography" in SEMINARS in ULTRASOUND, CT and MR; Grune & Stratton, Inc.,
>6:209; June, 1985.
>. Gill K, "Legal Liability and Sonography: An Update"; J Diag Med
>Sonography 1992; 8:93-96.
>. "SDMS Code of Conduct"; Society of Diagnostic Medical Sonographers,
>12770 Coit road, Suite 508; Dallas, TX 75251.
>. ARDMS Executive Office; "History of the ARDMS" in The American Registry
>of Diagnostic Medical Sonographers: Directory & Information Booklet, 1991;
>ARDMS, 2368 Victory Parkway, Suite 510, Cincinnati, Ohio 45206, 1991; p. 4.
>
>. Lumley J. Through a glass darkly: ultrasound and prenatal bonding. Birth.
>17(4):214-7, 1990 Dec.
>
>4. Langer M. Reinold E. [Psychological aspects of diagnostic methods in
>pregnancy]. [Review] [18
>refs] [German] Zentralblatt fur Gynakologie. 111(6):368-75, 1989.
>
>Good luck.
>
>Peace, Terry J. DuBose, M.S., RDMS, FAIUM
>University of Arkansas for Medical Sciences, USA
>Director, Diagnostic Sonography Program
>http://www.uams.edu/chrp/dmshome.htm <http://www.uams.edu/chrp/dmshome.htm>
>VOICE: 501-686-6510 FAX: 501-686-6513
>Chair, http://www.obgyn.net/us/us.htm <http://www.obgyn.net/us/us.htm>
>http://www.io.com/~dubose/ <http://www.io.com/~dubose/>
>Now is the time for all good folks to come to the aid of the Earth.
>----
>
