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Re: [echocardiography] Intraoperative TEE

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  • David Williams
    I presume that you have talked to your medical director. Do they expect the sonographer to both pass the scope and then acquire all the views himself? Or is
    Message 1 of 8 , Nov 30, 2009
      I presume that you have talked to your medical director.   Do they expect the sonographer to both pass the scope and then acquire all the views himself?    Or is the plan to have anesthesiologist pass the scope, and then hand the probe to the tech to acquire all the pre and post images?    Or, are they just telling you that they just expect you to offer the service of being there to assist either a cardiologist or TEE trained anesthesiologist  (i.e., so called, "knobologist", as someone else here has already posted)?

      Since you are asking the question here, I will further presume they are thinking option #1 or #2.   In either case, your medical director's request is inappropriate.   I dont know about Malyasia law, but here in US this amounts you you being ordered to practice medicine without a licence.    It is clearly outside the scope of practice for sonographer.    There are specific guidelines out there for TEE performance (I dont have off hand but check with ASE or ACC), and I'm quite sure that you either have to be a doctor, either a formally trained cardiologist in TEE or if an anesesiologist you may do a limited focus study but must have attended some specialized formal training also.  

      They just can't pawn it off onto the tech.    If this is not understandable to them, take it to your administration (isn't there a medical credentials person there?) and if administration folds then obviously you can take it higher to whatever governing external healthcare agency(s) are applicable over there.  

      Hang tough, and don't let them do this to you.   You could be held both criminally and civially responsible.

      Regards,
       
      Dave     




      -----Original Message-----
      From: Shafullah Serdari
      Sent: Nov 26, 2009 2:27 AM
      To: echocardiography@yahoogroups.com
      Subject: [echocardiography] Intraoperative TEE

       

      Dear all,

      I am cardiac sonographer/ Cardiovascular Technologist from Malaysia recently Our Medical director and the head of anesthetic has decided to implement the policy that sonographer has to extend their service to do interaoperative TEE.

      Since it is new field for us we need opinion from you or anyone regarding this, is it  good or bad for us?

      Just for your information pediatric sonographers in our hospital have performing interaoperative TEE  since 2004 it seems no problem but for us, adult sonographer we are rarely holding the TEE probe.

      Please share your opinion
       
      Thank you

      Shafullah RDCS, RCS, RCIS
      Deputy Manager
      Non Invasive Lab

    • David Williams
      I am correctly reminded by a member of this forum that my warning below about being criminally and civially responsible may or may not apply in this
      Message 2 of 8 , Dec 2, 2009

        I am correctly reminded by a member of this forum that my warning below about being "criminally and civially" responsible may or may not apply in this international setting.   As I mentioned in my post, "I dont know about Malyasia law", and I suppose it is certainly possible that the practice of techs performing TEE's may be entirely legal and/or even common in other countries.   I just don't know.     

         

        Certainly it was not my intention to give legal advice to Shafullah without a license while, ironically, advising him not to practice medicine without a license.     My apologies for any confusion..

         

        Dave    

        -----Original Message-----
        From: David Williams
        Sent: Nov 30, 2009 1:19 PM
        To: echocardiography@yahoogroups.com
        Subject: Re: [echocardiography] Intraoperative TEE

         

        I presume that you have talked to your medical director.   Do they expect the sonographer to both pass the scope and then acquire all the views himself?    Or is the plan to have anesthesiologist pass the scope, and then hand the probe to the tech to acquire all the pre and post images?    Or, are they just telling you that they just expect you to offer the service of being there to assist either a cardiologist or TEE trained anesthesiologist  (i.e., so called, "knobologist" , as someone else here has already posted)?

        Since you are asking the question here, I will further presume they are thinking option #1 or #2.   In either case, your medical director's request is inappropriate.   I dont know about Malyasia law, but here in US this amounts you you being ordered to practice medicine without a licence.    It is clearly outside the scope of practice for sonographer.    There are specific guidelines out there for TEE performance (I dont have off hand but check with ASE or ACC), and I'm quite sure that you either have to be a doctor, either a formally trained cardiologist in TEE or if an anesesiologist you may do a limited focus study but must have attended some specialized formal training also.  

        They just can't pawn it off onto the tech.    If this is not understandable to them, take it to your administration (isn't there a medical credentials person there?) and if administration folds then obviously you can take it higher to whatever governing external healthcare agency(s) are applicable over there.  

        Hang tough, and don't let them do this to you.   You could be held both criminally and civially responsible.

        Regards,
         
        Dave     




        -----Original Message-----
        From: Shafullah Serdari
        Sent: Nov 26, 2009 2:27 AM
        To: echocardiography@ yahoogroups. com
        Subject: [echocardiography] Intraoperative TEE

         

        Dear all,

        I am cardiac sonographer/ Cardiovascular Technologist from Malaysia recently Our Medical director and the head of anesthetic has decided to implement the policy that sonographer has to extend their service to do interaoperative TEE.

        Since it is new field for us we need opinion from you or anyone regarding this, is it  good or bad for us?

        Just for your information pediatric sonographers in our hospital have performing interaoperative TEE  since 2004 it seems no problem but for us, adult sonographer we are rarely holding the TEE probe.

        Please share your opinion
         
        Thank you

        Shafullah RDCS, RCS, RCIS
        Deputy Manager
        Non Invasive Lab

      • Mina Tohid
        Does anyone do Mobile diagnostic Echo and Vascular and Ultrasound?
        Message 3 of 8 , Dec 2, 2009
          Does anyone do Mobile diagnostic Echo and Vascular and Ultrasound?

          On Wed, Nov 25, 2009 at 11:27 PM, Shafullah Serdari <shafullahs@...> wrote:
           

          Dear all,

          I am cardiac sonographer/ Cardiovascular Technologist from Malaysia recently Our Medical director and the head of anesthetic has decided to implement the policy that sonographer has to extend their service to do interaoperative TEE.

          Since it is new field for us we need opinion from you or anyone regarding this, is it  good or bad for us?

          Just for your information pediatric sonographers in our hospital have performing interaoperative TEE  since 2004 it seems no problem but for us, adult sonographer we are rarely holding the TEE probe.

          Please share your opinion
           
          Thank you

          Shafullah RDCS, RCS, RCIS
          Deputy Manager
          Non Invasive Lab


        • Poobalan Munisamy
          Thank you for your concern.I am also a cardiac technician from one of the Malaysia private health care,when we had the JCI accredited ,it was clear that in
          Message 4 of 8 , Dec 2, 2009
            Thank you for your concern.I am also a cardiac technician from one of the Malaysia private health care,when we had the JCI accredited ,it was clear that in their chapter that a person who perform the TEE must been trained and competent cardiologist.For the matter competency need follow the country healtcare giudeline because ultimately the person who perform the TEE hold the responsability.As I knew in the other country such as USA/UK competency was a difficult things in their programme..

            --- On Mon, 30/11/09, dali fan <dfan1997@...> wrote:

            From: dali fan <dfan1997@...>
            Subject: Re: [echocardiography] Intraoperative TEE
            To: echocardiography@yahoogroups.com
            Date: Monday, 30 November, 2009, 7:32 AM

             
            Intraoperative TEE are exclusively performed by physicians in the 4 medical centers I have worked in MA and NY.
            It is difficult for people to performed intraoperative TEEs if they do not perform TEEs routinely
            Dali

            --- On Thu, 11/26/09, Shafullah Serdari <shafullahs@yahoo. com> wrote:

            From: Shafullah Serdari <shafullahs@yahoo. com>
            Subject: [echocardiography] Intraoperative TEE
            To: echocardiography@ yahoogroups. com
            Date: Thursday, November 26, 2009, 2:27 AM

             
            Dear all,

            I am cardiac sonographer/ Cardiovascular Technologist from Malaysia recently Our Medical director and the head of anesthetic has decided to implement the policy that sonographer has to extend their service to do interaoperative TEE.

            Since it is new field for us we need opinion from you or anyone regarding this, is it  good or bad for us?

            Just for your information pediatric sonographers in our hospital have performing interaoperative TEE  since 2004 it seems no problem but for us, adult sonographer we are rarely holding the TEE probe.

            Please share your opinion
             
            Thank you

            Shafullah RDCS, RCS, RCIS
            Deputy Manager
            Non Invasive Lab




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          • Shafullah Serdari
            Dear Dave,   You have valid points and it seems very scary for us to be there. Unfortunately from my knowledge there is to clear guidelines in our country
            Message 5 of 8 , Dec 3, 2009

              Dear Dave,

               

              You have valid points and it seems very scary for us to be there. Unfortunately from my knowledge there is to clear guidelines in our country stating who has privilege to perform TEE.

              Further more we are bound with the rule of our job scope where we are required to perform duties as instructed by Consultant Cardiologist/ Head Department.  

               

              According to the instructions we are not actualy required to insert the TEE but only to provide images so that the anesthetics and the surgeon are able to interpret the images. 

               

              In hospital, anesthetist can't perform 2 jobs in one time (TEE as well as anesthetizing the patient at the same time) therefore other person is required to do TEE. Because of the shortage of cardiologists and anesthetists the most possible is sonographers.

               

              I am not sure whether in all states in the US apply same regulation, from some information given to me by the Head of Anesthetist, state like Massachusetts allows sonographer to perform TEE.

               

              I read a paper published in JASE written by Mark S. Adam with the title of “The Cardiac Sonographer in Operating Room: Who’s Left Holding the Probe” and after reading this article it have an impression that Intraoperative TEE probably is one of a room of expansion for sonographers but I don know whether I am just pleasing my feeling for being “force” to do this job. Any way at the moment I don’t know whether I should accept or to not this job since there is strong base for us to reject.

               

               

              Regards

               

               

              Shafullah



              From: David Williams <davewill40@...>
              To: echocardiography@yahoogroups.com
              Sent: Tue, December 1, 2009 3:19:06 AM
              Subject: Re: [echocardiography] Intraoperative TEE

               

              I presume that you have talked to your medical director.   Do they expect the sonographer to both pass the scope and then acquire all the views himself?    Or is the plan to have anesthesiologist pass the scope, and then hand the probe to the tech to acquire all the pre and post images?    Or, are they just telling you that they just expect you to offer the service of being there to assist either a cardiologist or TEE trained anesthesiologist  (i.e., so called, "knobologist" , as someone else here has already posted)?

              Since you are asking the question here, I will further presume they are thinking option #1 or #2.   In either case, your medical director's request is inappropriate.   I dont know about Malyasia law, but here in US this amounts you you being ordered to practice medicine without a licence.    It is clearly outside the scope of practice for sonographer.    There are specific guidelines out there for TEE performance (I dont have off hand but check with ASE or ACC), and I'm quite sure that you either have to be a doctor, either a formally trained cardiologist in TEE or if an anesesiologist you may do a limited focus study but must have attended some specialized formal training also.  

              They just can't pawn it off onto the tech.    If this is not understandable to them, take it to your administration (isn't there a medical credentials person there?) and if administration folds then obviously you can take it higher to whatever governing external healthcare agency(s) are applicable over there.  

              Hang tough, and don't let them do this to you.   You could be held both criminally and civially responsible.

              Regards,
               
              Dave     




              -----Original Message-----
              From: Shafullah Serdari
              Sent: Nov 26, 2009 2:27 AM
              To: echocardiography@ yahoogroups. com
              Subject: [echocardiography] Intraoperative TEE

               

              Dear all,

              I am cardiac sonographer/ Cardiovascular Technologist from Malaysia recently Our Medical director and the head of anesthetic has decided to implement the policy that sonographer has to extend their service to do interaoperative TEE.

              Since it is new field for us we need opinion from you or anyone regarding this, is it  good or bad for us?

              Just for your information pediatric sonographers in our hospital have performing interaoperative TEE  since 2004 it seems no problem but for us, adult sonographer we are rarely holding the TEE probe.

              Please share your opinion
               
              Thank you

              Shafullah RDCS, RCS, RCIS
              Deputy Manager
              Non Invasive Lab


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