ULTRASOUND Messages for September, 1999: Re: OB Videotapes

Re: OB Videotapes

From: James S Smeltzer MD

gaperina@mindspring.com

Sun Sep 26 22:25:51 1999

Litigation fears as they affect the practice of medicine, do so in a negative way. Your duty to the patient is to provide at least a standard examination. A tape is the perfect way to document that examination, and meeting that standard. If a patient wants an archival record of the examination and will pay the cost, it is your duty to provide it. THE TAPE IS YOUR FRIEND! The standard of care is to look, not necessarily to see. Showing you looked, or tried to look, is sufficient to get you entirely off the hook IMHO.

We do not provide keep-sake tapes. We put it on & let it run usually. The sonogram has been proven to promote parent-child bonding and positive acceptance into the family. The videotape is an extension of this process to the other 20 members of the family you might object to being in the suite. Considering who you work for, you should not be considering your liability issues as some of the best sonologists around are there, and the entire state of New Jersey stands between you and the patient's attorney, so don't sweat it!

In my personal experience there has been a strong inverse correlation between the skills a sonographer or sonologist has and their objection to tape. The last one who objected strongly had good reason to - as she was the first, last & only one to miss a tri 18 in my lab, with micrognathia, characteristic fisting, rocker-bottom feet, IUGR and a large AV septal defect present at birth & never could learn to measure the cervix - missing an unknown number of opportunities to intervene and prevent a birth before term.

A patient's tape helped me to see the VSD I missed last year (and hopefully not miss a similar one again). I have dated patients by studies done before or done elsewhere based on the content of a tape they brought & their care has been improved. So both in QI and in care the tape has been a positive contribution. What is the hang up?

On the other side of the coin, the members of this forum weighing in strongly pro-tape are the ones I would want to have the first in-utero look at my granddaughter - and it's only partly because they would let me share in the experience vicariously. Mostly it's because they would get some pretty pictures! God knows when this is going to happen, however :(.

My sonographers get beautiful pictures and are not afraid to share them. I really really hope I never have to eat these words, but the best defense against this has been the exam the patient gets, and the positive sharing attitude the patient gets: No informed consent, no hiding the exam. Do your best & leave God & the lawyers fight over the rest! They will get what they deserve in the end. ;D Jim Smeltzer, MD

PS: The last Down's baby I diagnosed by prenatal sonogram was aborted. That was hard on my heart. Missing it could have landed me in court - for wrongful birth, or saving a baby by accident?! Think about it. JS

At 11:08 PM 9/18/1999 -0500, you wrote: >Jim,
>I think we may be talking about two separate issues. Yes, patients
>should have access to their records, including diagnostic images. Our
>policy refers instead to keepsake videotapes, which are not part of the
>diagnostic procedure. I believe that professional integrity is the
>greatest incentive to perform thorough, meticulous examinations, and
>that's what ultimately results in the greatest patient satisfaction.
>
>Regards,
>Paula
>
>At Thu, 16 Sep 1999, James S Smeltzer MD wrote:
>>
>>Paula,
>>
>>I know that we need to be cost-effective, but not at the expense of
>>inadequate examinations. I know that giving the patient an archive of the
>>exam is a strong disincentive to do an inadequate one. Jim S
>>
>>At 09:05 PM 9/12/1999 -0500, you wrote:
>>>Hi, Paige.
>>>
>>>I believe the SDMS has a policy statement on keepsake videotapes.
>>>
>>>Unlike performing sonograms for entertainment, not diagnosis (something
>>>I believe almost all of us oppose), should we be making keepsake videos
>>>in the course of an exam? This was a hot topic in our department.
>>>
>>>The sonographers (myself included) were unanimously opposed to them.
>>>Some physicians thought it was a nice gesture, and others worried about
>>>issues of time, medicolegal ramificatons, and patient dissatisfaction if
>>>they could not see "the baby."
>>>
>>>I should note that whenever possible, we do give one or two keepsake
>>>images. In theory, a videotape is just a variation of that. Our
>>>opposition was based on practical concerns, not philosophical ones.
>>>Ultimately, those practical concerns guided our action. At a business
>>>meeting, we voted against making keepsake videotapes. Now, when a
>>>patient asks for one, the sonographer says, "I'm sorry, but there's a
>>>department policy against it."
>>>
>>>Before your administrators come to a decision, they should be prepared
>>>to answer:
>>>
>>>Who would provide the tape? How would it be paid for? How much time (per
>>>fetus and per pregnancy) should be devoted to making the tape? Who
>>>should make it--doctor or sonographer? Should a doctor review each tape
>>>before it's released? What happens if a videotape is used in a lawsuit?
>>>Do you need to keep a copy of each tape the way you keep the other
>>>images? Do you only offer to tape singleton pregnancies? Sonographically
>>>normal ones? Only at a certain gestational age?
>>>
>>>The administrators should remember that insurers are trying to cut
>>>reimbursement rates, which means we have to try to improve efficiency.
>>>Are they willing to support the extra time videotapng takes if it
>>>reduces volume by a patient a month? A week? A day?
>>>
>>>Finally, would they be considering providing keepsake videos of the
>>>patients' gallstones or sonohysterograms instead of their fetuses?
>>>Obstetrical ultrasound is no less of a detailed, specialized, diagnostic
>>>medical procedure. Where will they draw the line?
>>>
>>>Good luck. I'd like to hear the outcome.
>>>
>>>Regards,
>>>Paula
>>>
>>>At Sun, 12 Sep 1999, PFC wrote:
>>>>
>>>>I know this subject has come up many times but I was not successful in
>>trying to find info in the archives.
>>>>
>>>>I need information that will support a decision and formal written policy
>>against video taping for the patient. Has anyone been involved in a lawsuit
>>or know of any? Are there any guidelines set out by SDMS or ARDMS? We
>>need some solid information to pass on to the administrators so that they
>>can make and informed decision.
>>>>
>>>>Thanks for your help! BTW, can anyone tell me how to use the archives?
>>>>
>>>>Paige Cobb BS, RDMS, RVT
>>>
>>>--
>>>Paula S. Woletz, RDMS, RDCS, MPH
>>>University of Medicine and Dentistry of New Jersey/
>>>St. Peter's University Hospital
>>>New Brunswick, NJ
>>>woletzps@umdnj.edu
>>>
>
>--
>Paula S. Woletz, RDMS, RDCS, MPH
>University of Medicine and Dentistry of New Jersey/
>St. Peter's University Hospital
>New Brunswick, NJ
>woletzps@umdnj.edu
>

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