Jack Pfenninger writes:
An US unit that plugs into a laptop...... it seems like the real deal. It may be just what primary care was waiting and looking for. I think NPI could gear up to teach US much like it did to teach colposcopy and colonoscopy. Maybe there’s even a place for a new society of “Primary Care Ultrasonography”!!!
WMR Replies:
We tested the "plug -in to a laptop" models from Terason 1999--2001. Rich Usatine went on to buy 4-5 for his lab at UTexasSanAntonio 2002-2007. I've used them.They are good, but ultrasound's #1 application for community medicine remains Ob-Gyn. OB has been abandoned by 75% of academic family physicians and nonacademic FP's. This has limited the teaching of ultrasound skill within the specialty of Family Medicine. Ultrasound should be as common as the iphone, but it will not be for a variety of complicated reasons related to our dysfunctional model of medical education and health care economics.
Our study of ultrasound prevalence continues. Using 2009 data on a full service family medicine office currently seeing approx 3700 patients for the month of July. We delivered 45 patients that month and will deliver about 450 for the year at this office. To tighten up on "reporting bias" observed in a previous study, we installed mandatory capture tracking on two machines. This is what they counted in July. there is one other machine whose data does not capture. We also send some out. Therefore these numbers are, while seeming high to non OB generalists, are conservative estimates of valid ultrasound needs.
Ultrasound exams counted by hard copy tracking July 2009
OB with images 193
OB pyschosocial no billing, no images 75
Gyn 32
Abdominal 20
Breast 1
thyroid 1
Testicles 1
Abcess 1
As we reported in several studies, family medicine systematically undercounts the ultrasound needs of women with reproductive issues.The first study documented the large numbers of exams needed by women who do not deliver at the medical home 2004-2006. Women with miscarriages and complications require extra ultrasounds. GDM surveillance for AFI/EFW generates additional ultrasound exams.This was a partial explanation for the unexpectedly large number of ultrasounds documented in the Memphis-Milwaukie study below.
Rodney WM, Martinez CM, Chiu KW, Carson G, Garcia RL. Prenatal patients not delivered: Unplanned events, uncounted services , and risks. Am J Clin Med Spring 2009; 6[2]: 31-36. Also peer reviewed and selected for presentation at the 2008 AAFP Scientific Assembly San Diego, Ca.
This next study produced data on several issues but one of them was ultrasound revenue associated with ultrasound services 2000-2003. While improving the quality of care, ultrasound more than pays for itself even in this predominantly medicaid and uninsured community.
Rodney WM, Hardison D, McKenzie LD, Rodney-Arnold KMM. The Impact of Deliveries on the Office of Family Physicians. J Nat Med Assoc. October 2006; 98: 1685-1690.
This study found similar frequencies ranging from 114-297 ultrasounds per 100 deliveries 2001,2002, 2003 using Milwaukie as a comparison to Memphis. The numbers were unexpectedly high, but consistent. Thee numbers have been replicated above.
Dresang LT, Rodney WM, Rodney KMM. Prenatal ultrasound: A tale of two cities. J Nat Med Assoc. Feb 2006;98:167-171.
http://www.nmanet.org/JMNA_Journal_Articles/feb-06-jnma/OC167.pdf
The term "primary care" continues to be a destructive replacement for family medicine obstetrics and rural hospitals who need a blend of FP-ER-OB. I went to the Alabama Rural Health meeting and not one main stage speaker spoke the F word--Family Medicine. The tree of Family Medicine remains lost in a forest of generic primary care. When the chair or director does not support prenatal care with ultrasound by FP's in the FP office, their is little hope for those residents to acquire skills in this area. Without OB, purchase of the ultrasound equipment will be difficult to justify. Without ultrasound skills the care of women will not be as good as it could be.
With best wishes for your professional success,
Wm. MacMillan Rodney MD, FAAFP, FACEP
American Board of Family Medicine Obstetrics
Medicos para la Familia
Nashville, Memphis, and International
www.psot.com
[TheProcedural Skills and Office Technology Project]
Index--ultrasound eqipment, computer plug in model available
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