Here is a question for all the ultrasonographers out there.
Here is a question for all the ultrasonographers out there.
I studied ultrasound in human medicine,as many of you probably. I was always amazed to see the difference on the way the referring physicians request their studies, only focusing in the “presumed problem system” instead of a whole body scan as we do.
I understand that sometimes in our profession is much harder to narrow down the patient signs to a certain organ or system, but oftentimes that is not the case, and we just wanna have a look at the urinary tract or reproductive, for example.
Do you consider this practice as totally inappropriate for our patients, or it is only something that general practitioners could request without fear of being accused of overlooking at things? From a cost point of view, I think it could help if we could offer limited scans for those cases that are appropriate, understanding just as they do with humans that a more complete approach should be given to those cases that deserve so.
Would love to hear your opinion.
Thanks,
Silvana
Comments
As a DVM, there are
As a DVM, there are situations, but few, where I will perform a limited scan. A hematuria case sometimes will only get a bladder and kidney scan. Sometimes also at recheck appointment if monitoring a spleen or liver mass but do prefer to look at everything as things change rapidly sometimes. Otherwise I strive for a complete scan as it does not take that much longer nor is the cost that much greater – you are already there.
Beyond that, in veterinary medicine we often only have one “crack” at the patient and really need to try and gather the whole picture of our patients as they can not communicate for themselves and we need to come up with the most cost efficient timely plan at the time. We also sometimes only have the attention of a particular client for so long and if we are not solving the problem they will go elsewhere quite easily for a second opinion and the next clinic just may find that lesion we missed and now we are considered incompetent. In human medicine, at least here in Canada, it is impossible to get a second opinion and you are pretty much stuck with the doc you have. IMO, a limited scan could actually end up costing the client much more in the future if significant findings are missed.
I had a conversation with my GP once about “limited” scans in human medicine. Part of the reasoning, whether this is true or not, was that they did not want to find “incidental stuff” that may lead to further un-needed testing that could cause patient morbidity and cost the health care system. I guess you could also argue this on the veterinary side as well. Also, at least this is how it works in Canada, we can go get multiple scans without it costing us anything – in vet med this not the case so you better go in a get a good scan when you can.
Just my two cents – I am all for complete scans in veterinary patients.
Jacquie
As a DVM, there are
As a DVM, there are situations, but few, where I will perform a limited scan. A hematuria case sometimes will only get a bladder and kidney scan. Sometimes also at recheck appointment if monitoring a spleen or liver mass but do prefer to look at everything as things change rapidly sometimes. Otherwise I strive for a complete scan as it does not take that much longer nor is the cost that much greater – you are already there.
Beyond that, in veterinary medicine we often only have one “crack” at the patient and really need to try and gather the whole picture of our patients as they can not communicate for themselves and we need to come up with the most cost efficient timely plan at the time. We also sometimes only have the attention of a particular client for so long and if we are not solving the problem they will go elsewhere quite easily for a second opinion and the next clinic just may find that lesion we missed and now we are considered incompetent. In human medicine, at least here in Canada, it is impossible to get a second opinion and you are pretty much stuck with the doc you have. IMO, a limited scan could actually end up costing the client much more in the future if significant findings are missed.
I had a conversation with my GP once about “limited” scans in human medicine. Part of the reasoning, whether this is true or not, was that they did not want to find “incidental stuff” that may lead to further un-needed testing that could cause patient morbidity and cost the health care system. I guess you could also argue this on the veterinary side as well. Also, at least this is how it works in Canada, we can go get multiple scans without it costing us anything – in vet med this not the case so you better go in a get a good scan when you can.
Just my two cents – I am all for complete scans in veterinary patients.
Jacquie
I totally agree with Jacquie
I totally agree with Jacquie as limited exams will bite you and everyone involved in the backside sooner or later. Here in NJ where there are 8 referral facilities and 4 sonogrpahy groups in a 2 hour radius everything has the potential to get rescanned by usually someone who has at least journeyman level or better sonography skills and some that are very talented. So lets say i just do a urinary scan for the hematuria patient and I find a stone but don’t go cranial and look at the adrenals and panc and Gi and liver and gb. That patient…hematuria patients are usually middle aged to older… very well may have a sublinical live rtumor, GB mucocele, gastric FB or mural lesion, pancreatitis and adrenal mass as these ancillary things i see all day long. Even if a young hematuria patient with a stone….go look for that shunt that is subclinical too as i back into shunt dx often when there is a stone in a young hematuria dog.
On top of that the owner hears “ultrasound” not single cavity ultrasound and the unprofessional second opinion sonographer relates “why wasn’t this seen before on the prior US”….as they conveniently forget or avoid the “limited scan” issue..its an ugly world out there especially when money is involved and when you slice it all up its really all about the money issue. I have had this discussion before many times and avoiding the single cavity scans is part of taling the high road on cases…at least look through the rest and if you decide not to charge a full thats an individual market and client issue but I suggest against this as well.
I totally agree with Jacquie
I totally agree with Jacquie as limited exams will bite you and everyone involved in the backside sooner or later. Here in NJ where there are 8 referral facilities and 4 sonogrpahy groups in a 2 hour radius everything has the potential to get rescanned by usually someone who has at least journeyman level or better sonography skills and some that are very talented. So lets say i just do a urinary scan for the hematuria patient and I find a stone but don’t go cranial and look at the adrenals and panc and Gi and liver and gb. That patient…hematuria patients are usually middle aged to older… very well may have a sublinical live rtumor, GB mucocele, gastric FB or mural lesion, pancreatitis and adrenal mass as these ancillary things i see all day long. Even if a young hematuria patient with a stone….go look for that shunt that is subclinical too as i back into shunt dx often when there is a stone in a young hematuria dog.
On top of that the owner hears “ultrasound” not single cavity ultrasound and the unprofessional second opinion sonographer relates “why wasn’t this seen before on the prior US”….as they conveniently forget or avoid the “limited scan” issue..its an ugly world out there especially when money is involved and when you slice it all up its really all about the money issue. I have had this discussion before many times and avoiding the single cavity scans is part of taling the high road on cases…at least look through the rest and if you decide not to charge a full thats an individual market and client issue but I suggest against this as well.
Thanks Eric and Jacquie for
Thanks Eric and Jacquie for your comments.
I agree that we all feel ” safer” looking at the whole abdomen to get a clearer picture of the patient’s situation, that’s no doubt. But it should be the same criteria for human medicine, shouldn’nt it then? I was also thaugth to define organ’s echogenicity by comparison to others, for example, yet another reason to perform a full scan…
Is only thinking how they can work their diagnostic with specific information, and wondering why is it that we, as veterinarians and ultrasonograpers do not accept it for our patients. For a lot of people that can’t afford tests it could represent a viable alternative, with reduced costs. Having said this, I am too scared to try it myself and miss something that could have changed the course of the treatment / prognosis completely! I guess I should talk to a human technician to hear their side of the story.
Thank you for listening 🙂
Silvana
Thanks Eric and Jacquie for
Thanks Eric and Jacquie for your comments.
I agree that we all feel ” safer” looking at the whole abdomen to get a clearer picture of the patient’s situation, that’s no doubt. But it should be the same criteria for human medicine, shouldn’nt it then? I was also thaugth to define organ’s echogenicity by comparison to others, for example, yet another reason to perform a full scan…
Is only thinking how they can work their diagnostic with specific information, and wondering why is it that we, as veterinarians and ultrasonograpers do not accept it for our patients. For a lot of people that can’t afford tests it could represent a viable alternative, with reduced costs. Having said this, I am too scared to try it myself and miss something that could have changed the course of the treatment / prognosis completely! I guess I should talk to a human technician to hear their side of the story.
Thank you for listening 🙂
Silvana
Believe me, after recently
Believe me, after recently deaing with supposed human specialists in a medical workup scenario, those in this forum are light years ahead int he diagnostic efficiency department than our human counterparts. The stabilized protocols are way behind the abilities of implementing current thought processes combined with available technology. We are basically aliens in the system. Politically incorrect? Of course…effective in getting the answers fast or proactively??.. of course so who can truly argue?
Believe me, after recently
Believe me, after recently deaing with supposed human specialists in a medical workup scenario, those in this forum are light years ahead int he diagnostic efficiency department than our human counterparts. The stabilized protocols are way behind the abilities of implementing current thought processes combined with available technology. We are basically aliens in the system. Politically incorrect? Of course…effective in getting the answers fast or proactively??.. of course so who can truly argue?