QUESTIONS:
As we prepare to buy an US for use in our office with prenatal patients the following question came up: Doesn't this open the practice up to claims of missed diagnosis?
Does anyone have a consent policy or form that attempts to define for the patient what office based OB US is capable of?
The prenatal providers are not alarmed by this perceived responsibility we feel exposed as it is by doing prenatal care and delivery, but the non maternity providers feel it will begin a process where their liability will increase. Any comments or practical tips?
John Bucek, MD
Somerset Family Practice Residency Program
Somerville NJ
COMMENTS ON LISTSERV:
I would certainly expect that having ultrasound in the office will increase your liability. I would strongly suggest you talk to your carrier before you purchase and use an ultrasound machine. Ultrasound is not a typical procedure for family physicians, especially in New Jersey, and I imagine many carriers would use this to dump you into a radiology category and that means huge increases in premiums.
Keith Stafford, MD
Greer, SC
Formerly of Flemington, NJ
Further Comments:
Having paid malpractice premiums on family medicine with OB ultrasound in the office dating back to 1984 the states of California, Tennessee, and Arkansas-- there has been no increase in liability insurance premium. No increase in premiums have been reported in our network of ob interested family physicians in Texas, Alabama, Missouri, Washington, Nevada, the Carolinas, and Midwest.
In fact I do not know of one example which follows the prediction made by Dr. Stafford. If there is one insurance company that has a policy such as the one described [in writing] I will stand corrected. For years family physicians have suffered at the hands of speculation like this. Actually all data suggest that liability decreases due the power of the diagnostic technique. The physician on bicycle will always be beaten by the physician driving a Buick. Therefore it goes against the self interest of the insurance company to develop a policy "dumbing down" their physicians.
With very little ultrasound training, physicians can immediately detect multiple gestation and a variety of conditions which always do better with early detection. Even "non-OB" physicians have a horse in this race, because women will be walking into their offices with a wide variety of menstrual irregularities and pelvic pains. All suits against physicians, and I have served as an expert witness for over 20 years, have been for errors of omission and prenatal care ignorance. Transvaginal ultrasound is particularly well suited to the primary care office that provides care for women. Women prefer that this exam be done by someone they know.
Our insurance policies cover the interpretation of diagnostic ultrasound along with our ability to interpret other tests such as ECG, chest radiographs, etc.
As a member of the RRC 1994-2000, I was frustrated to hear these unsubstantiated opinions from educators in urban university environments where family medicine was restricted to a "med-peds" format. Several New Jersey residency directors (DR BUCEK WAS NOT ONE OF THEM) wrote to the RRC with that tired and politically suicidal refrain about dropping OB "because nobody does it." Although the struggle in New Jersey is a difficult one, scholarship should lead us to the conclusion that ultrasound in the office is something that will immediately provide a higher quality of health care for our patients. Statesmanship requires a vision and idealism on behalf of the greater good. Let's work together to support it.
Wm MacMillan Rodney MD
Adjunct Professor of Family Medicine
Adjunct Professor Surgery/Emergency Medicine
Meharry/Vanderbilt School of Medicine
Medicos para la Familia
Memphis and Nashville, Tn.
www.psot.com
