Who's doing your scan? A reply to Dr Seitz

Thank you for this thought-provoking response to our editorial [1]. The editorial was intended as an overview of practice and to bring this to the attention of users of ultrasound, many who are not aware of practice in other countries [2].

There are points that need some clarification. Firstly, the use of ultrasound should not be compared with the use of a stethoscope; ultrasound is far better! Such comparisons underestimate the skill required to perform high level ultrasound examinations and perpetuate the myth that ultrasound is facile, effortless and can be done by anyone who buys a machine. Perhaps by using this analogy, there is contradiction to the argument, which is that ultrasound should be used only by physicians. By undermining the skills required to obtain and interpret ultrasound images, less conscientious physicians may fail to see the need to seek adequate training. As stated in our editorial, we emphasise that the UK model is successful largely because of robust ultrasound education, which produces intelligent analytical sonographers who consistently offer a quality diagnostic service.

Furthermore, there is insistence to separate the ultrasound examination performed by a physician from that performed by a sonographer. The inference is that physicians take a holistic approach whereas sonographers perform a robotic isolated scan by completing a series of “tick box” tasks. This is not the case in the UK, where sonographers perform scans only when accompanied by relevant clinical history. They converse with the patient and use the transducer to palpate areas of interest such as veins, ovaries, gallbladders, appendices and inguinal hernias. Furthermore, being almost exclusively hospital-based, sonographers have the advantage of being able to view full previous imaging history and are able to obtain second opinions when required. This is not possible from an isolated office-based practice. UK sonographers certainly make diagnoses that physicians trust and on which management decisions are made.

Lastly, point-of-care ultrasound is no longer an emerging specialty but is well established with many advocating its value both in the emergency department and “in the field”. This is not necessarily the domain of physicians in the UK, where again sonographers frequently support training in this area and also contribute to many hospital-based “one-stop” services thereby expediting patient management.

In today’s healthcare arena there is more than enough ultrasound work for all properly trained practitioners irrespective of background. Everybody with the requisite education, training and ability, plus the insight to work within their expertise, should be able to pursue an interest in the modality of ultrasound, which is both an adjunct to clinical practice for physicians and a reliable diagnostic tool for imaging specialists.

• References

• 1 Seitz KH (letter). Ultraschall in Med. 2017; 38: 661-663 . doi:10.1055/s-0043-122440
• 2 Edwards HM, Sidhu PS. Who’s doing your scan? A European perspective on ultrasound services. Ultraschall in Med 2017; 38: 479-482