Wait, what did you just say?!

Image result for what did you just say? meme anchorman

As the role of clinical ultrasonography continues to grow throughout healthcare, the need for clear communication of bedside findings has never been greater. We know that communication plays a major role in high quality healthcare, and that miscommunication has been identified as a major contributor to medical error and patient complaints.

Last year at SASKSONO17 (Breaking the Sound Barrier), we discussed the need for clear communication amongst clinicians. Our panel of experts (Internist, Intensivist, Emergentologist and Hospitalist) offered great advice on how best to communicate clinical ultrasound (aka POCUS) findings with colleagues and consultants (you can check out the 8 minute video here: https://vimeo.com/215476593).

But clear communication with colleagues is only one piece of the puzzle. The other big piece is clear communication with the patient! And while this may seem self-evident, we suggest there’s more to it than simply applying basic clinician-patient communication skills. For example, I am sure you have heard a trainee or colleague say to their patient, after having completed a bedside scan, that everything looks OK. Seems harmless doesn’t it? But to the patient, there is now a very real potential for misinterpretation of both the purpose of the scan, and the findings! Here at Sasksonic we’ve heard it first hand. Patients have returned to their primary care providers with impressive stories of whole body scans where their liver, spleen and kidneys were evaluated by ultrasound and “Great news doc, everything was OK!”

Image result for houston we have a problem

By not clearly stating the indications for the scan, or not clearly explaining the findings, clinicians may give their patients the wrong impression that they have undergone a much more comprehensive evaluation than intended or necessary. This can lead to a lot of headache and frustration by downstream providers who now find themselves rummaging through the patient’s medical record looking for the “whole body scans” (assumed to be either consultative ultrasound or CT scans) when no such studies were performed. Furthermore, in the absence of a consultative report (or worse yet, no comments regarding to the point of care ultrasound in the visit note), it can also negatively impact the status of clinical ultrasonography in the eyes of our colleagues and patients. As an important and evidence-based part of the clinical assessment (now proposed to be the 5th pillar of the bedside assessment – inspection, palpation, percussion, auscultation and insonation), we need to ensure our colleagues and patients understand the role clinical ultrasonography plays in patient care.

The solution?

Whenever possible, clearly communicate with patients about the indications, findings and limitations of the clinical ultrasound scan in question. When performing a FAST scan this means letting the patient know you are looking for free fluid in the abdomen or chest, which if seen, would suggest internal bleeding. If no free fluid is seen, instead of saying “everything looks OK” we suggest you say “I don’t see any free fluid on my scan, but this clinical application of ultrasound has limitations and sometimes we miss injuries. Keeping the clinical picture in mind, I think we should proceed with…”

And there’s more! Whenever possible, be sure to give the patient a clear understanding of what the scan will include including where the transducer will be placed. Be sure to warn them about the room temperature gel that often feels ice cold. Then, while scanning, try to talk them through the findings as much as possible (this gets easier as your image generation skills improve). For example, when scanning the gallbladder for suspected cholelithiasis, take time to show them their gallbladder, what the wall looks like and whether there are any stones. Remember, one of the advantages of clinical ultrasonography is that you are learning about your patient’s (patho)physiology in real time at their bedside. So let the patient know what’s going on in the moment, tell them in a way they will understand, and quell their curiosity while also empowering them!

For an example of good communication with a patient (and other aspects of ultrasound etiquette) , check out this short clip we’ve prepared at Sasksonic for our trainees.

cheers,

Paul Olszynski and Qasim Hussain

Peer Review: Drs. Kish Lyster and Irene Ma

 

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