Sunday, March 07, 2010

Question du jour: X-rays and ultrasounds

Our resident troll, OC, has been insisting that most doctors don't show x-rays and ultrasounds and other medical imaging results to patients prior to treatment. But my experience has been otherwise.

I've had two dental procedures done within the past month. Both dentists showed me the x-rays and explained why they were recommending the treatment they were about to do. In fact, I don't recall a single dentist who failed to show me the x-ray and point out the problem and explain what they were going to do. That includes the dentists I went to in Korea who didn't share a language with me and had to go through a translator.

I recently had a suspicious mammogram. The doctor showed me the films and the mass. He explained what he was recommending and why. I watched realtime as he did the ultrasound. He explained what he was seeing and pointed the mass out to me and explained why he wanted to do a biopsy. I watched the ultrasound during the biopsy, and again the doctor explained what he was seeing and what conclusions he was drawing.

Every family member or friend I can recall who had diagnostic imaging done was shown the diagnostic image. This is particularly true in obstetrics, where I've never heard of not showing the ultrasound to the patient unless the ultrasound is being done for an elective abortion.

What have your experiences been?


Kathy said...

Yeah, I've always been able to see my dental X-rays -- most memorably when the dentist showed me that the cavity that was causing pain was in my partially erupted wisdom tooth, rather than the one next to it, as I had thought (based on where I felt the pain).

When I thought my young son had broken his elbow or wrist or something because he wasn't using his arm, they showed me the X-ray and that it wasn't broken (although she failed to point out the hairline fracture in the wrist, which I noticed later, and was irritated that she didn't think it worthy of telling me, considering that it caused some slight swelling and bruising).

My husband still has the X-rays showing the shrapnel in his humerus from when he was shot.

I had an u/s done on my heart, which I saw on the screen, although I couldn't tell much of what was going on. And, of course, when I had an u/s during pregnancy, I saw the whole thing.

Lauren said...

I don't think I've ever NOT seen an x-ray or an ultrasound. That includes ultrasounds I was having done to look at ovarian cysts. In fact, pretty much every specialist or ER I've ever been in has a display board set up to show x-rays. OC is just wrong on this.

OperationCounterstrike said...

Oh brother. Now you're misquoting me. I didn't say you don't (usually) get to see your pictures; I said SEEING THEM IS NOT A NECESSARY PART OF INFORMED CONSENT.

Christina, you may need to take remedial reading skills.

Christina Dunigan said...

Why would the doctor show them to the patient, if they're not a part of informed consent? Seems to me that pointing at things in the medical image and telling the patient what it is and why the doctor is recommending a particular course of treatment IS PART OF INFORMED CONSENT.

Why do YOU think doctors show the medical images to the patient? Because they're pretty?

OperationCounterstrike said...

Christina, since you ask, usually when docs show pics to patients they're showing off. "I know how to read what this pic means, and you don't!" is the subtext.

My point is the pix are not NECESSARY for informed consent. If your doc says "Your leg is broken so I'm gonna put it in a cast" and you say "OK, doc!", you've just given informed consent, EVEN WITHOUT SEEING PIX.

Get it now? I'm not sure how many more ways of explaining this I can think of for you.

OperationCounterstrike said...

Sometimes showing pix to patients is good for dr-patient relations, makes the patient feel empowered, involved in his/her decisions. Most patients, though, won't understand their pix and aren't interested anyway. Like I said before, the very large majority of patients wanna know WHAT WILL I SUFFER and WHAT SHOULD I DO and you can keep the rest to yourself as far as they're concerned.

I understand your impulse to share with the patients, to have an ideal relationship in which the patient is a partner in the medical decisions, etc. But I'm telling you, you would shed that impulse in your first week on the hospital wards, or you would sink without a trace and flunk out. It's just not practical, not real-world. In clinical rotations you need to focus on doing what is required of you and not look for additional frills and nicey-nicenesses.

OperationCounterstrike said...

Informed consent does NOT mean understanding the moral implications of what you are consenting to.

You can give informed consent for a surgery without being informed how many animals were tortured and sacrificed in order to develop the surgery.

OperationCounterstrike said...

The above is true EVEN IF you are someone to whom animal rights are very important.

WKen said...

My mother has a bone spur in her left foot.

She hasn't been allowed to schedule the surgery until the x-rays were done and shown to her.

I think that she might really like to like in OC's world for that part of it, since this slowed down the operation that she'd really like to get over with.

(I offered to amputate, but she passed on that.)

Kathy said...

...the very large majority of patients wanna know WHAT WILL I SUFFER and WHAT SHOULD I DO and you can keep the rest to yourself as far as they're concerned.

So, if a woman wants to get a breast augmentation or reduction, is it part of informed consent to tell her that she may not be able to breastfeed future children, or should the doc just keep that to himself?

If a person is going to be treated for cancer, and that treatment will render him/her sterile, is it part of informed consent to tell him/her that s/he will no longer be able to have children if s/he has the chemo, radiation, etc., or should the doc just keep that to himself?

Zoe the Short said...

When I've broken bones, I've not seen the x-rays, and I'm OK with that. I can feel the bones rubbing against each other just fine, thanks. My dentist does not show me my x-rays, but he does view them where I can see them.

I was struck this morning by the similiarity between medical images as discussed here and the images the weatherman shows on TV. They tell us what they see, but we don't have the training to confirm or deny. I don't like seeing those images either. Don't waste my time- tell me what I need to do in my situation, or what you're going to do to fix it.

Christina Dunigan said...

Actually, you could argue that in most cases, abortion is probably the ONLY surgery for which the medical imaging is totally NECESSARY. You are ordering somebody to be put to death. You may be squirming out from under the reality of that behind typical prochoice "blob of tissue" or "clump of cells" to get yourself through the procedure. But unless you know EXACTLY WHAT IS BEING DESTROYED at your behest, you're not informed.

I realize that the prochoice are very much in favor of keeping women as ignorant as possible about what abortion in general -- and the woman's pondered abortion in particular -- destroys. Some of that's paternalistic OC style, 'Let's not overwhelm the poor little dear with stuff she's too addlepated to understand!" (Pats patient on the head.) Some of it's greed. ("I have to keep this facility afloat and I'm not gonna do that if I don't sell our services") and some of it's philosophical ("I don't give a rat's ass about the fetus, so neither should she!") LOTS of reasons for keeping women isolated and ill-informed.

But it's inexcusable. The fact that OC defends it -- on the ground that what the dumb twats don't know won't hurt them, and if any woman with any fucking sense would kill the little vermin anyway -- is just another reason to say it's inexcusable.

Tonal Bliss said...

I think what is being missed in many of these posts is surprisingly basic.

A patient can refuse to have diagnostic images shown to him/her. However, a primary care provider (PCP) should never hide nor deny a diagnostic image from being shown to a patient. There should be no doubt that a PCP should certainly always offer the diagnostic imaging to be shown to the patient. By common sense, most PCPs show the diagnostic imaging as a courtesy without being asked and will not show them if the patient so desires.

In the case of many abortion providers, the diagnostic imaging (ultrasound) is often hidden from patients and sometimes denied to be shown to the mother of the unborn. This general fact in and of itself is a grave injustice. This is not a matter of the patient refusing to see the diagnostic imaging. This is a case of the PCP not wanting the patient to see them. Here lies the HUGE difference.

OperationCounterstrike said...

Kathy, yes, if breast augmentation carries a risk of difficulty breastfeeding in future, teh patient needs to know that. That's part of the answer to the question WHAT WILL I SUFFER.

OperationCounterstrike said...

Same with your example of the cancer treatment that makes you sterile. If the treatment is gonna make you sterile, the docs have to tell you that, and knowing that IS part of informed consent because it's part of WHAT WILL I SUFFER.

Christina Dunigan said...

Remorse at finding out too late that what you did was kill an embryo with arms and legs and a beating heart is something that a woman will SUFFER if information is withheld from her prior to the abortion.

Your presumption, OC, is that the patient will remain in blissful ignorance forever. When she finds out that the "blob of tissue" description was a blatant lie, you, the abortionist, are nowhere to be found. You're not the one to listen to her cry, to suffer with her through sleepless nights, to find her lifeless body when she overdoses on sleeping pills washed down with vodka.

And frankly I don't think you give a rat's ass if the patient feels regret or remorse afterward. You have expressed repeated loathing of the whole idea of childbirth and seem to be on some sort of vendetta to abolish it.

OperationCounterstrike said...

GG, first of all, there's not enough evidence that enough women feel significant guilt or remorse about their abortions to make it an issue. Even you can only list anecdotes, not numbers, so there is no evidence that more than a small handful of abortion patients feel ANY GUILT AT ALL.

Secondly, ordinary guilt is not a medical issue. Informed consent means knowing the MEDICAL risks. The fact that I might feel guilty for getting a surgery which was developed by torturing animals is NOT part of informed consent to that surgery. For informed consent, you only need to know the MEDICAL risks.

You're wrong, I have sympathy for women who regret their abortions. I just think 1. there aren't very many of them, 2. they mostly don't regret their abortions VERY MUCH, and 3. THE FACT THAT PEOPLE REGRET SOME DECISIONS IS NOT A GOOD REASON TO TAKE THE DECISION AWAY FROM THEM. Some people regret going to Princeton rather than Yale, but that's not a reason to outlaw Princeton.

Christina Dunigan said...

OC, since the remorse can be FATAL, it seems pretty significant to me. And it's 100% preventable. You can easily screen out the women who will, after the fact, regret having killed something that they consider to be a baby by letting them see it before you kill it and make a fully informed choice regarding whether or not they really are comfortable having it killed at their behest. If the woman is not completely comfortable with having that particular fetus, at that stage of development, destroyed, then the doctor can refer to somebody who will help them to address their social concerns without resorting to killing that fetus.

If, as you assert, most women have absolutely no qualms about having the fetus destroyed on their behalf, there should be no problem for them to see it ahead of time, declare it to be a loathsome and horrific parasite, and be glad that they verified the presence of the intruder before having you fatally run it off.

And I think you're totally full of shit about having sympathy for women who regret their abortions, since you repeatedly dismiss them as beneath your concern. Let them die and decrease the surplus population! As long as the women with no capacity for regret or remorse are happy, it doesn't matter if other women hang themselves or shut themselves up in the garage with the car running.

OperationCounterstrike said...

GG, driving can also be fatal. (Excuse me, FATAL). So let's outlaw driving!

And did you say "shut themselves up in the garage with the car running?" That is a very stupid and uncertain method of suicide! You need cyanide, dear, cyanide.

Christina Dunigan said...

Did I tell you I wanted you and other abortionists to outlaw abortion? NO. I have repeatedly told you and other abortion proponents that what I want you to do is to show concern for the women as individuals, not as wombs to be scraped out in a tally for "choice".

Show her the ultrasound. Say, "Okay, many women are distressed to the point where it disrupts their lives, and even leads to suicide, when they get this information after the abortion and it is too late to factor it into the choice. Because the risk of not giving you this information is so great -- potentially life threatening, I'm giving it to you. This is your fetus on the ultrasound. You can see the arm there, the fingers, they eyes and nose and mouth. There is the heart beating. If you are comfortable with destroying that embryo, we'll go ahead with the abortion. If you're not, we will refer you to some people who will help you to explore other ways to deal with your situation."

And I'm afraid it's too late to tell Carol Cunningham that you scoff at her choice of suicide methods.

Not that you're flippant or anything.

WKen said...

Christina, I commend your patience in trying to reason with the troll.

The truth is, though, that once the sanctity of life has been subordinated to a political dogma, that's going to have to include all life. Even the women supposedly being protected are less important than the cause.