Scanning Where it Hurts

​Let’s say it’s a typical work day at your clinic or hospital. Halfway through a scan, while chatting comfortably with your patient, they mention a pain they’ve been having in a different part of their body. You can see that they are anxious about it and that it’s been on their mind for a while.

You want to help because you can understand the hassle and waiting that making another doctor’s appointment will require. But at the same time that area isn’t mentioned on the patient’s requisition and it’s a busy day, as is every day, and you are mindful of the waiting room full of other patients ahead of you.

You are uncertain of the parameters of your job in this situation. What do you do? 

The first few times I had this experience as a new tech I had no idea what the right choice was. So I decided to ask around and see what other techs had to say.

​I found that there are two fairly equally divided answers to this question.

Some techs don’t want to look anywhere other than what is stated on the requisition, in the interest of protecting themselves and working within the defined permissions of their job.

And others decide that taking a quick look at the new area just to make sure nothing appears grossly abnormal is part of their responsibility to do the most good for the patient that can be done in the allotted time.

I found that I fall into the second category. 

Now I’m not telling anyone what the right answer is in this situation. I just find it to be something that wasn’t talked about all that much during training but that I feel deserves more consideration and discussion.

These are my reasons for extending the parameters of my job as a tech. They are deeply personal, but that is how we make these choices and I share them with you so that you can become aware of your reasons for making choices like this in your career. 

First, the personal reason, my mother had both breast cancer and endometrial cancer a few years ago so I have been through all the fear and anxiety that come with that diagnosis and treatment. I empathize deeply with women who have had cancer, mets and treatment and if they are anxious about something and I can ease their anxiety by scanning for a few extra minutes, then I will do so without hesitation. 

And secondly, the logical reason. I have, without even trying, stumbled across multiple incidental findings in ultrasound exams so I know how common they actually are. I can think of a half dozen off the top of my head right now. And I’m glad that I found those. It means I’m thorough, I’m good at my job. I feel that the best way to protect myself and my employer is by being as thorough as I can with each patient. 
​
Overall I want my patient to leave feeling that the best was done for them that could be done and that means that sometimes I need to look in a few places other than what are explicitly stated on the paperwork.

It usually doesn’t take more than a few minutes, and the one or two times a year that you actually find something can mean the difference between quick treatment and recovery for the patient, or more discomfort, anxiety and possibly discovery once it is too late to treat the problem effectively. 

​My reasons are both personal and logical but I am able to clearly explain them. This is a key concept to understand when working in ultrasound. Sometimes we make decisions that need to be explained because our choices can have repercussions and we must be aware of this. Having ready an explanation that is clear to both ourselves and others is necessary if we want our decisions to be respected. 

What choices have you made? And when you think back, how did you justify your actions? I’d love to hear your take on this issue.
​
Happy Scanning!