Episode 22: Do an H/P, But Don't Forget Ultrasound

by Bob Stuntz in


Episode 22 is a response to an article on KevinMD from April 2014, "Forget Ultrasound, Do a Proper History and Physical Instead."  In this article, written by a radiologist, Dr. Saurabh Jha (@roguerad - follow him.  I do, very interesting thoughts and perspective), the argument is made that POC US is being done indiscriminately, instead of a good H/P.  Amongst other things, the article concludes that POC US is bad for patients, costing taxpayer money and leading to over testing and over diagnosis.  POC US has been similarly accused recently in regards to leading to over testing (see this thought provoking post from EM Nerd).  Dr. Jha's article was originally written in response to this article from NEJM, which sang praises for POC US, but did have some mischaracterizations.  

Admittedly, we may have overall overreacted a bit to this article as can be seen in the comments (the title alone is inflammatory, but frankly KevinMD often is recently).  Dr. Jha made the following clarification in the comment section:

"I'm advocating against indiscriminate use of ultrasound, as routine, as a substitute or extension of H & P (see NEJM article), not against selective use of imaging within clinical context."

We agree in some respects:

  1. We should all absolutely be doing a good H/P, and using US as a diagnostic test in the clinical context of our patients.  
  2. We should all be properly trained. 
  3. US is not a simple, learn this overnight kind of thing.  It takes dedicated training, and constant learning and practice - which we do well in the POC US community. 
  4. The US is not a stethoscope, nor is it an extension of your physical exam, and should not be used indiscriminately.

But, the physical exam is not so great:

  1. How good is a Rovsing's sign?
  2. How about a Homan's sign?  See here or here
  3. Murphy's sign?

One thing we do know is that POC US does have a positive impact on patient care through faster door to diagnosis times, faster throughput, and improved patient satisfaction, based on previous POC US studies.  

Announcements:

  1. Want to write for the EM Res Blog?  Have an idea for an article, or even a series (US of the week, Image of the week…)?  Want to help with podcast episodes?  I want to expand the EM Res Blog and Podcast, but I need your help to do it.  Residents, educators, anyone anywhere - send your ideas to me at bobstuntzmd@gmail.com or @BobStuntz, and let's see if we can make this thing even better!
  2. Please go join our Google Community.  The goal is to have this be a place that EM residents and educators (you can help answer resident questions) can get together to discuss resident issues and questions, both clinical and non-clinical.  Great discussion this week on ketamine for post intubation sedation. 
  3. Tumblr Users: I'm aware of the video issue and will do my best to get it to cross over.  Consider following the blog here at emrespodcast.org, or subscribe to the RSS feed.  Getting a bunch of new Tumblr followers recently, so want to make sure this is working out for you.  

Now, onto the Podcast:

Listen here or listen below: