I have read the reviews regarding my service to patients in the Tarzana office. I am amazed at the diversity of opinions regarding the experience of patients. Perhaps an explanation of our practice may be helpful.
When patients are referred for diagnostic ultrasound by their obstetrician the expectations vary. Some are not sure why they are referred, others just want to know the sex of the baby, while others understand that the referral is to evaluate the health and well-being of their unborn child.
From some of the reviews I have been characterized as someone who is "evil" to someone the patient is grateful that she saw. What is baffling, is that I am the same person, irrespective of the circumstances. Perhaps an explanation of my philosophy regarding patient care may be helpful.
1. When I enter the room I introduce myself, and welcome the patient.
2. I ask why she was referred to me for an ultrasound. The reason for the referral is on the document I review, but I always ask the patient because sometimes the reason the physician lists for the referral is different than what the patient understands.
3. As I begin the examination I explain what I am going to do. During the examination I concentrate on what I am imaging. I often am quiet as I concentrate on the images. What many do not realize is that I have a significant responsibility to carefully evaluate the anatomy of the fetus which requires an in-depth understanding of the anatomy of the brain, heart, abdomen, and other structures.
4. After I finish the examination, I try to point out structures that the patient might recognize such as the spine, beating heart, and sex of the fetus. In addition, I attempt to obtain a 3D image of the fetal face or other structures that the patient may recognize.
5. At the conclusion of the examination I explain my findings. If the examination is normal, patients leave the room happy and comforted that all appears to be well. At the conclusion of the examination I provide the patient with a free DVD of the entire examination, free hard copy pictures, and a free set of pictures that are uploaded to their smartphone.
6. Before the patient leaves the room I ALWAYS ask if she has any questions that I have not answered.
WHAT HAPPENS WHEN I FIND SOMETHING WRONG?
This is the most difficult time for the patient and me. The trouble with finding something "wrong" is that there may be a misunderstanding as to what the findings mean as the patient interprets what I have to say. Perhaps the following may be helpful.
1. Not all abnormal ultrasound "findings" mean that there is a major problem. An example that the reader of my comments might relate to is if your physician informed you that you have high blood pressure. High blood pressure is a symptom that may or may not have consequences such as a risk for stroke, heart attack, and even an untimely death. However, the physician has the obligation to inform the patient of the finding and the potential consequences. An abnormal fetal finding may or may not have consequences. However, it is my responsibility to inform the patient of the risk for associated birth defects that may have more signifiant consequences. For example, there may be ultrasound findings that raise the risk for chromosomal abnormalities, or other serious neurological diseases. When further testing is performed and the results confirm that indeed there is a major problem, patients appreciate that they have the information as it helps them to plan for the remainder of the pregnancy.
2. However, when the ultrasound findings suggest a risk for a more serious problem, but further testing reveals that a serious problem is not present, some patients become angry because they were unnecessarily "scared". Subsequently, some write unkind reviews about how they were made to have "unnecessary tests", etc.
3. The additional tests when an abnormal ultrasound finding is identified usually involve genetic tests obtained from maternal blood or from amniocentesis. While I have been accused of doing these tests to "make more money", this is not true. I do not receive any money for ordering laboratory tests, as this is illegal. In addition, I have no financial interest in the laboratories who run the tests.
4. I do not relish informing patients of abnormal findings. However, it is my obligation to do so and provide the insight gained from 30 years of experience. My goal is to help insure the health of the unborn child and do all I can to preserve life. However, I also have the obligation to not force my personal beliefs about the sanctify of life on those who may disagree. Each person has their free agency to choose what path they take when confronted with difficult issues. I may not personally agree with a person's choice, but I respect their agency to choose as they may. read more
