Misconceptions About Point-of-Care Ultrasound

Misconception #1: Does this matter? I’m not trying to do radiology.

Ultrasound at the point-of-care is becoming a tool that almost all specialties need to use. The increased access to handheld ultrasounds precipitates this further. While the full ultrasonographic workup the radiology department does is something that cannot be replaced right now, all specialties can benefit from being able to do quick exams on the spot.

Consider this: cardiologists are good at using their stethoscope to distinguish various sounds like murmurs. But non-cardiologists need to be able to do this as well to a certain extent. Can you imagine having to get a cardiology consult every time you wanted to listen to someone’s heart? Ultrasound will soon become the same way. You shouldn’t need to call in a consult if you just want to take a quick look.

Misconception #2: The current physical exam is good enough

When Laennec invented the stethoscope, his intention was to find a way to look at the chest (hence the name “scope” — microscope, periscope, etc.). We now have the technology to do what Laennec could not, i.e. actually look inside! The current physical exam is an art that takes years to perfect. While there is great beauty in the techniques and the inferences you can make from physical examinations, it takes many years and experience with many patients to finally get comfortable with it. Ultrasound has a little bit of a learning curve, but because it is an inherently visual medium, it is much easier to achieve standardization and consistency of result interpretation.

Consider this, when you are doing a stethoscopic examination, there is no way you can ensure that you are hearing the same sounds your teacher is hearing. The following is an all too common scenario in medical training:

               Attending: Do you hear the late systolic murmur?

               Medical student: Sure? (*doesn’t even know there’s a murmur. panics.*).

That’s why it takes so much experience to comfortably recognize patterns. With ultrasound, because you are looking at the tissues along with a mentor, it is a lot easier to tell if you are recognizing the same patterns. All of a sudden, both the mentor and the mentee have the same point of reference.

Misconception #3: More technology is cold and impersonal

It is often brought up that technology is making the doctor-patient relationship much less personal. While increased diagnostic testing can add an impersonal side to medicine, ultrasound might be an exception to that trend. When you are performing an ultrasound exam, especially one with a portable machine at the point-of-care, the physician is forced to spend time with and actually make contact with the patient. In addition, because others can now see what you are looking at, there is an opportunity to explain to both the patient and to other members of the care team what exactly you are looking at, while empowering the patient to feel like they have bigger role in their care.

Misconception #4: You can’t possibly do that much with those tiny portable machines

While image quality and other factors (lack of pulse and continuous wave doppler) make some current handheld machines unable to do full ultrasonographic workups, having 2D and color doppler (which all the machines at Mt. Sinai have) can be enough to get you significantly closer to your diagnosis. Check our last blog post with the table from Moore et al!

Misconception #5: Isn’t this club taking it a little overboard?

Other schools have fully embraced the clinical and didactic utility of ultrasound. The University of South Carolina has designed a program that integrates ultrasound education into all four years of the medical training of every student. Other schools like UC Irvine have also been pioneers in this regard. So in addition to these other schools having active ultrasound interest groups (like ours), they also provide classroom time for all students to achieve a minimum competency with the modality.