The fundamental difference between veterinarians and ultrasound technicians
I’ve seen quite a few cases recently where very competent scanning professionals within our community have found something that doesn’t look right, referred it to the vet as they should, only for the vet to give the animal the all clear and send her straight home. No feedback is given either by the vet or the owner to the person who made the referral, and this can be very disconcerting. You might feel any or all of the below:
- Guilty for “wasting” the owner’s time and causing unnecessary stress.
- Filled with self-doubt: did you get it wrong?
- Like you’ve been dismissed and undermined by the veterinarian.
Experiences like these can really damage your confidence. You’re never going to be there during the consultation and you will never know what the vet said or thought. Yes, a small minority may indeed be dismissive of your skills, but if they are, this is more of a reflection on their own lack of scanning experience than your own. After all, you’ve probably scanned more pregnant bitches than they have, so if you think something looks unusual, have faith that it is.
One thing it is very important to remember, though, is the fundamental difference between the ultrasound technician and the clinician in terms of priorities. Your focus is on the ultrasound scan, but unless they also specialise in imaging, the veterinarian’s attentions and priorities lie elsewhere. In both the human and animal worlds, well-intentioned clinicians will take a “hands off” approach as much as possible: “first, do no harm.” That means that even if something is abnormal, they will be reluctant to take action if their patient is not experiencing symptoms or at imminent risk of becoming seriously unwell. In the veterinary world there’s also the added element of financial cost. For all you know, the vet may have agreed that something wasn’t quite normal and have offered the owner further investigations, but on the basis that their pet was currently well and the vet did not anticipate an imminent deterioration, they may have declined. The pet owner is unlikely to ever disclose this to you.
Sonographers experience this, too!
I have experienced the same thing many times when scanning human hearts. I remember one specific incident where I noticed something termed “mitral annular disjunction” – an unusual movement of one of the walls of the heart and the mitral valve apparatus. There is no doubt that this movement is pathological, and there is strong evidence to show that it is linked – among other things – to potentially fatal arrhythmias. Sometimes the first sign of this disease is sudden cardiac death. I felt that this was something worth reporting and drawing attention to.
Apparently, I was wrong. I remember seeing my comment removed from the report by the cardiologist and feeling hurt, and a little angry. This was a very unusual condition that I only knew about because of my own hours of ‘extra-curricular’ research and reading, and I had spotted it incidentally in a patient that was still fit and well – in time for them to be helped. Instead of being thanked for making such a discovery, my observation was being completely dismissed!
After I’d got over feeling upset, I thought about it for a while, and I realised the difference between me and the cardiologist. I don’t treat patients. I don’t request further tests for them, I don’t make diagnoses, and I don’t make any decisions over interventions. My entire focus was on the ultrasound, which was abnormal. The patient, however, was not. The patient was young and asymptomatic. What consultant is going to tell a young person with no cardiac symptoms that they should have a pacemaker fitted, just in case at some point in the next 60 years they experience a fatal arrhythmia? What guidelines exist to even enable them to do this? What are the ethics surrounding even telling somebody about a condition from which they may never experience symptoms, and which can’t ever be ‘fixed’?
As frustrating as it was to discover something abnormal on ultrasound and not have it acted upon, I managed to get over the knock to my confidence by realising that my priorities and perspective will always differ from the clinician’s. It will always differ from the veterinarian’s, too. Sometimes a vet won’t take action in response to your scan not because they think you’re wrong, but because they just don’t believe that intervention would be in the best interests of the animal. They will sadly never communicate this to you, and most likely, they won’t communicate it to the owner, either.
A good veterinarian who works in partnership with their local scanner should commend the technician’s diligence, but if they don’t and if you feel that that pet owner is left feeling aggrieved at the “unnecessary” referral, all you can do is remember the alternative: to not refer, and have that animal on your mind and your conscience for weeks, months or the rest of your life – and that’s no alternative at all.
Lack of action is not a reflection upon your skills
Vets not taking action in response to your ultrasound findings will happen to you repeatedly. It does not necessarily mean that they disagreed with you, and it certainly does not mean that you were wrong.
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