One approach to this dilemma is to recognize the hand-held device for what it is. It is a miniature version of the larger but more capable standard high-end ultrasound machine. Recognizing the differences between the two is fairly easy to instill in healthcare providers because there is a precedent. It is well known that transesophageal echocardiography may be necessary in some patients because the standard echocardiogram will not provide all the required information. Similarly, the standard echocardiogram may be necessary to supplement incomplete information obtained by the hand-held device. Once complete information is gathered by the standard high-end echocardiogram, it may be perfectly acceptable to use a hand-held device for a focused, goal-oriented limited follow-up study. As with other aspects of the practise of medicine, a qualified, properly trained health practitioner will need to assume responsibility (and will be held accountable) for how the information is obtained and interpreted. Proper record-keeping is essential. Reimbursement issues will doubtless also influence the eventual role of hand-held ultrasound in cardiac diagnosis and treatment.
Proper utilization is further refined by a plan to use the hand-held device extensively for bedside teaching of both patients and healthcare providers. A sonographer performing a study in an echocardiography laboratory without a physician is legally prohibited from discussing the echocardiographic findings with the patient. As a result, patients usually leave the echocardiography laboratory somewhat disappointed that the images of their heart were not explained to them during the study. On the other hand, a properly trained and credentialled physician coming to the bedside with a hand-held device can use it to educate the patient as well as the rest of the healthcare team. Such an approach can integrate the visual information from the ultrasound device with the auditory information from the stethoscope, thereby increasing skills in both techniques.
Many people feel that the stethoscope hanging around the neck of healthcare workers is already just a symbol, and no longer provides adequate diagnostic information. For the near future at least, stethoscopes should continue to hang there, waiting to be used by those who know auscultation, while echocardiograms (hand-held or standard) should be performed and interpreted by those who know echocardiography. Ôûá