Monday, May 07, 2018

How over-reporting on ultrasound scans harms infertile patients

Vaginal ultrasound is an extremely useful tool when evaluating an infertile woman, but it often bothers me because there are some sonographers who over interpret the scan images. Now, I like the fact that they are careful and systematic, and document everything they see by taking lots of images. However,  I hate the fact that draw clinical conclusions based on the black and white images they see on the screen - and they shouldn't be doing this.
Their reports will say things like, " There are adhesions between the ovary and the uterus"; " There is a 3 cm endometriotic cyst";  the fallopian tubes are thickened."
None of this is true. Endometriosis is a clinical diagnosis , which can only be confirmed by a clinician when he actually puts a telescope inside the abdomen.  Yes, we can suspect the diagnosis, but it's not one which a sonographer should be making !  Thus, you can assume there are likely to be adhesions, but you can't be sure about this, until you can actually see them !  And finally, no one in the world can actually see fallopian tubes on an ultrasound scan. To claim they are thickened is ridiculous !
They take lot of measurements - all of which are completely bogus because they are all pseudo accurate. So, they will say things like, " The cyst is 2.56 centimeters." How can an ultrasound machine possibly measure to the accuracy of 0.01 centimeters ?
Interestingly, these sonographers are very popular with most doctors, who are happy to refer all their patients only to them. They are happy to take advantage of these "abnormalities" which the sonographer has so kindly diagnosed. They then tell the patient they need to evaluate these findings, and subject the poor patient to even more tests and treatments - most of which are completely uncalled for, and just a waste of time and money.
I understand the importance of detail, but this kind of misleading detail actually just ends up backfiring, and creates a lot of unhappiness both for the good clinician as well as the patient. It causes the poor patient a lot of unnecessary anxiety  , because she then spends hours on google trying to decipher the report! After this research, she is convinced she has all the possible medical problems in the world, and will never be able to get pregnant !
This diagnostic over-labelling causes these sonographers to lose credibility with good clinicians. They are unhappy with this kind of reporting, because they have to spend their time reassuring the patient that ultrasound scans have lots of limitations, and over-interpreting the images often causes other doctors to jump to the wrong conclusion !
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