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Re: [Spam] Re: [echocardiography] Re: Writing reports

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  • Gerson Lichtenberg
    Correct Jason, but if you look at Colette s comment on 11/17 you ll see where we started talking about issuing reports without physician review. Gershom
    Message 1 of 23 , Dec 1, 2007
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      Correct Jason, but if you look at Colette's comment on 11/17 you'll see where we started talking about issuing reports without physician review.
      Gershom Lichtenberg, RDCS
      Haifa, Israel

      On Nov 20, 2007 9:46 PM, Grabham, Jason W <jwgrab2@...> wrote:

      Maybe I'm confused…  I thought the original issue was sonographers generating reports for the interpreting cardiologist.  Not giving prelims to requesting physicians.  Two issues at opposite ends of the spectrum. 

       

      Jason Grabham, RDCS

      Technical Director

      Pediatric & Fetal Echocardiography

      859.257.5129

      859.323.2699 (fax)

       

      The contents of this email and any attachments are confidential and are intended soley for the addressee.  The information may also be legally privileged.  This transmission is sent in trust, for the sole purpose of delivery to the intended recipient.  If you have received this transmission in error, any use, reproduction or dissemination of this information is strictly prohibited.  If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this message and any attachments.

       


      From: echocardiography@yahoogroups.com [mailto:echocardiography@yahoogroups.com] On Behalf Of Lynda Hopkins
      Sent: Sunday, November 18, 2007 10:14 PM
      To: echocardiography@yahoogroups.com
      Subject: [Spam] Re: [echocardiography] Re: Writing reports

       

      I've been reading this series of postings with interest and disappointment
      that this issue is prevalent on both sides of the Pacific. Gerson, I'm with
      you. I am an experienced, qualified and accredited sonographer. I have
      taught and examined in cardiac ultrasound for over 10 years. I do not and
      will not issue a sonographer report for any study that I perform. I
      discuss my findings with the members of our Cardiology Team to alert them to
      a study that needs urgent reporting. Of course I can interpret my images,
      I do not however have a medical degree with advanced training in cardiology
      which is both the legal and moral requirement for the interpretation and
      reporting of an echocardiogram. Our hospital is a small teaching facility,
      our cardiologists report all routine echocardiograms within 24 hours,
      usually less. Our cardiology registrars (completing advanced training as
      cardiologists) will issue interim reports but these are always verified by a
      consultant. We all work together to provide an expert service. The
      philosophy here is that if a patient needs an urgent study, then they
      require an expert medical opinion. Give the service you would like to
      receive, Colette. I've been on both sides of the patient equation and I
      can assure you that I would not like to be treated on the advice of a person
      without the appropriate medical qualification and training, however much I
      respect my health professional colleagues. That second pair of eyes looking
      at each study is an incredibly powerful compliment when you are right, and
      life-saving if you are not.

      I'm retiring next year, but I can see that in future I shall have to ask
      "Who will be reporting this study?" every time I or my husband have a
      diagnostic procedure performed. This makes me very concerned as true
      expert medical opinion on an ultrasound scan discovered a life-threatening
      condition for which I received early treatment.

      Please, sonographers, stand up for yourselves. Be proud of who and what
      you are. Not issuing interim reports is in your patients' interest, it is
      not a slight on your professional standing. And patient care is what its
      all about, isn't it?

      Lynda Hopkins BA L&D, DMU (Cardiac), AMS
      Frankston Hospital, Victoria, Australia.

      ----- Original Message -----
      From: "Gerson Lichtenberg" <gershomsl@...>
      To: <echocardiography@yahoogroups.com>
      Sent: Sunday, November 18, 2007 3:18 AM
      Subject: Re: [echocardiography] Re: Writing reports

      > Actually, Colette, I would talk about a lawsuit rather than pressure.
      > If this is done as a routine then either your 'urgent studies' are not
      > deemed urgent by your supervisory physician staff or your institution
      > just loves to keep its lawyers busy. While there could conceivably be
      > a situation in which I might do this (it would have to be as unusual
      > as the cardiologist is killed en route to the hospital and I see
      > something that clearly is threatening the patient's life) in which I
      > might consider the risk to the patient to be overwhelming the
      > professional and financial safety of myself, my family and my
      > employer.
      >
      > By the way, the physician is paid for an interpretation to help in
      > patient management. If all of the clinical decisions have already been
      > made based on your interpretation, there is really no reason for the
      > insurance company or government to pay them.
      >
      > Since, to the best of my knowledge, no U.S. laws or ultrasound
      > certifying agencies in the U.S. support the use of sonographer
      > impressions for clinical management, you are out there on a limb to
      > begin with. There are some that believe that making a diagnosis is one
      > part of 'practicing medicine.' Is there something that would protect
      > you in court for doing this without a medical license?
      >
      > Please speak with your institution and explain that you are putting
      > them as well as yourself at risk while issuing your preliminary
      > reports to make emergency decisions. Is there a written institutional
      > policy that empowers or requires you to do this? Please get a copy of
      > it in your personal home records. If this does not exist, please
      > insist that they give a written instruction to you, signed by an
      > administrator. If they will not do this, then clearly they have no
      > intention of defending what you do.
      >
      > Gershom Lichtenberg, RDCS
      > Haifa, Israel
      >
      > On Nov 17, 2007 6:45 AM, clttrae <clttrae@...> wrote:
      > >
      > >
      > >
      > >
      > >
      > >
      > > Isn't this what we all do. I do cardiac, general, OB and vascular.
      > > Generally, the MD just dictates my impression and signs. On the
      > > weekends and after hours I don't even have a rad around. I send
      > > patients to surgery or ship them out all the time. Talk about
      > > pressure.
      > >
      > > Colette in Calif
      > >
      > >
      > > --- In echocardiography@yahoogroups.com, a b <ginalulubaby@...> wrote:
      > > >
      > > > More or less, that's what we do. The preliminary report is
      > > completed by sonongraphers, the physician makes changes, or not, and
      > > signs it. I would've thought most places do it that way, no?
      > > >
      > > >
      > > > grandia52 <grandia52@...> wrote: I
      > >
      > > have a new assignment as a temp in a hospital covering weekends. I am
      > > > expected not only to do the echo, but to generate a complete
      > > report for
      > > > the physician to just sign. While I am capable of doing this,I
      > > beleive
      > > > it is beyond my "scope of practice". Any comments? Joanne
      > > >
      > > >
      > > >
      > > >
      > > >
      > > >
      > > > ---------------------------------
      > > > Never miss a thing. Make Yahoo your homepage.
      > > >
      > >
      > >
      > >
      >
      >
      >
      > Yahoo! Groups Links
      >
      >
      >


    • a b
      I guess that s a fair question; maybe I misunderstood, too. Joanne, are you saying you re being asked to write a preliminary report for your cardiologist, or
      Message 2 of 23 , Dec 3, 2007
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        I guess that's a fair question; maybe I misunderstood, too.  Joanne, are you saying you're being asked to write a preliminary report for your cardiologist, or give a final report to the ordering physician?

        "Grabham, Jason W" <jwgrab2@...> wrote:
        Maybe I’m confused…  I thought the original issue was sonographers generating reports for the interpreting cardiologist.  Not giving prelims to requesting physicians.  Two issues at opposite ends of the spectrum. 
         
        Jason Grabham, RDCS
        Technical Director
        Pediatric & Fetal Echocardiography
        859.257.5129
        859.323.2699 (fax)
         
        The contents of this email and any attachments are confidential and are intended soley for the addressee.  The information may also be legally privileged.  This transmission is sent in trust, for the sole purpose of delivery to the intended recipient.  If you have received this transmission in error, any use, reproduction or dissemination of this information is strictly prohibited.  If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this message and any attachments.
         

        From: echocardiography@ yahoogroups. com [mailto: echocardiography@ yahoogroups. com ] On Behalf Of Lynda Hopkins
        Sent: Sunday, November 18, 2007 10:14 PM
        To: echocardiography@ yahoogroups. com
        Subject: [Spam] Re: [echocardiography] Re: Writing reports
         
        I've been reading this series of postings with interest and disappointment
        that this issue is prevalent on both sides of the Pacific. Gerson, I'm with
        you. I am an experienced, qualified and accredited sonographer. I have
        taught and examined in cardiac ultrasound for over 10 years. I do not and
        will not issue a sonographer report for any study that I perform. I
        discuss my findings with the members of our Cardiology Team to alert them to
        a study that needs urgent reporting. Of course I can interpret my images,
        I do not however have a medical degree with advanced training in cardiology
        which is both the legal and moral requirement for the interpretation and
        reporting of an echocardiogram. Our hospital is a small teaching facility,
        our cardiologists report all routine echocardiograms within 24 hours,
        usually less. Our cardiology registrars (completing advanced training as
        cardiologists) will issue interim reports but these are always verified by a
        consultant. We all work together to provide an expert service. The
        philosophy here is that if a patient needs an urgent study, then they
        require an expert medical opinion. Give the service you would like to
        receive, Colette. I've been on both sides of the patient equation and I
        can assure you that I would not like to be treated on the advice of a person
        without the appropriate medical qualification and training, however much I
        respect my health professional colleagues. That second pair of eyes looking
        at each study is an incredibly powerful compliment when you are right, and
        life-saving if you are not.

        I'm retiring next year, but I can see that in future I shall have to ask
        "Who will be reporting this study?" every time I or my husband have a
        diagnostic procedure performed. This makes me very concerned as true
        expert medical opinion on an ultrasound scan discovered a life-threatening
        condition for which I received early treatment.

        Please, sonographers, stand up for yourselves. Be proud of who and what
        you are. Not issuing interim reports is in your patients' interest, it is
        not a slight on your professional standing. And patient care is what its
        all about, isn't it?

        Lynda Hopkins BA L&D, DMU (Cardiac), AMS
        Frankston Hospital , Victoria , Australia .

        ----- Original Message -----
        From: "Gerson Lichtenberg" <gershomsl@gmail. com>
        To: <echocardiography@ yahoogroups. com>
        Sent: Sunday, November 18, 2007 3:18 AM
        Subject: Re: [echocardiography] Re: Writing reports

        > Actually, Colette, I would talk about a lawsuit rather than pressure.
        > If this is done as a routine then either your 'urgent studies' are not
        > deemed urgent by your supervisory physician staff or your institution
        > just loves to keep its lawyers busy. While there could conceivably be
        > a situation in which I might do this (it would have to be as unusual
        > as the cardiologist is killed en route to the hospital and I see
        > something that clearly is threatening the patient's life) in which I
        > might consider the risk to the patient to be overwhelming the
        > professional and financial safety of myself, my family and my
        > employer.
        >
        > By the way, the physician is paid for an interpretation to help in
        > patient management. If all of the clinical decisions have already been
        > made based on your interpretation, there is really no reason for the
        > insurance company or government to pay them.
        >
        > Since, to the best of my knowledge, no U.S. laws or ultrasound
        > certifying agencies in the U.S. support the use of sonographer
        > impressions for clinical management, you are out there on a limb to
        > begin with. There are some that believe that making a diagnosis is one
        > part of 'practicing medicine.' Is there something that would protect
        > you in court for doing this without a medical license?
        >
        > Please speak with your institution and explain that you are putting
        > them as well as yourself at risk while issuing your preliminary
        > reports to make emergency decisions. Is there a written institutional
        > policy that empowers or requires you to do this? Please get a copy of
        > it in your personal home records. If this does not exist, please
        > insist that they give a written instruction to you, signed by an
        > administrator. If they will not do this, then clearly they have no
        > intention of defending what you do.
        >
        > Gershom Lichtenberg, RDCS
        > Haifa , Israel
        >
        > On Nov 17, 2007 6:45 AM, clttrae <clttrae@yahoo. com> wrote:
        > >
        > >
        > >
        > >
        > >
        > >
        > > Isn't this what we all do. I do cardiac, general, OB and vascular.
        > > Generally, the MD just dictates my impression and signs. On the
        > > weekends and after hours I don't even have a rad around. I send
        > > patients to surgery or ship them out all the time. Talk about
        > > pressure.
        > >
        > > Colette in Calif
        > >
        > >
        > > --- In echocardiography@ yahoogroups. com, a b <ginalulubaby@ ...> wrote:
        > > >
        > > > More or less, that's what we do. The preliminary report is
        > > completed by sonongraphers, the physician makes changes, or not, and
        > > signs it. I would've thought most places do it that way, no?
        > > >
        > > >
        > > > grandia52 <grandia52@. ..> wrote: I
        > >
        > > have a new assignment as a temp in a hospital covering weekends. I am
        > > > expected not only to do the echo, but to generate a complete
        > > report for
        > > > the physician to just sign. While I am capable of doing this,I
        > > beleive
        > > > it is beyond my "scope of practice". Any comments? Joanne
        > > >
        > > >
        > > >
        > > >
        > > >
        > > >
        > > > ------------ --------- --------- ---
        > > > Never miss a thing. Make Yahoo your homepage.
        > > >
        > >
        > >
        > >
        >
        >
        >
        > Yahoo! Groups Links
        >
        >
        >


        Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

      • Keith
        Hi Joanne You may want to refer to the ICAEL and ASE guidelines. It is clearly stated in the ICAL documentation that prelims and reports are a nono and the ASE
        Message 3 of 23 , Dec 11, 2007
        • 0 Attachment
          Hi Joanne

          You may want to refer to the ICAEL and ASE guidelines. It is clearly
          stated in the ICAL documentation that prelims and reports are a nono
          and the ASE has a paper on their website (FAQ sonographer issues). I
          would give this info to the hospital and your recruiter and if its not
          addressed pass on that assignment. Malpractice is a scary word.


          --- In echocardiography@yahoogroups.com, "grandia52" <grandia52@...>
          wrote:
          >
          > I have a new assignment as a temp in a hospital covering weekends. I am
          > expected not only to do the echo, but to generate a complete report for
          > the physician to just sign. While I am capable of doing this,I beleive
          > it is beyond my "scope of practice". Any comments? Joanne
          >
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