r/emergencymedicine • u/Former_Bill_1126 ED Attending • Jul 20 '24

Advice US won’t come in if pain >12hrs

Working at a new site, US techs are very picky, will not come in for torsion studies if pain is >12hrs. I talked her into coming in and she’s pissed af, said she knows I’m new and “I’ll learn the protocol”.

Am I in the wrong?

Edit: Does anyone support the US tech or rad protocol and do you have any studies or evidence to support this practice? I’m just wondering if they pulled this out of their ass or where they got the arbitrary 12 hour thing?

160 Upvotes

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522

u/Drew_Manatee ED Resident Jul 20 '24

Sounds like your next patient will have been having pain for only 10 hours. And then once the US tech gets to the hospital you can let them know you must have misheard the patient and as it turns out, their pain has been for more than 12 hours. "But since you're already here, why don't you just scan them anyway?"

Alternatively wait until after the scan to report that the patient is now remembering they had the pain for more than 12 hours. Those silly patients, always losing track of time.

165

u/Former_Bill_1126 ED Attending Jul 20 '24

Yeah, it’s actually an NP patient, but I wasn’t comfortable with them not getting the US so called the tech back myself. I told him my new thing will be “yeah patient says 3 days of pain but it suddenly got worse 11 hours ago”

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u/KumaraDosha Jul 20 '24

And this is why ultrasound techs don’t trust y’all. Do not do this.

56

u/Retroviridae6 Resident Jul 21 '24

An ultrasound tech is not a doctor. If a doctor wants an ultrasound done, it should be done. The ultrasound tech's job isn't diagnosis or management but to do an ultrasound.

-14

u/KumaraDosha Jul 21 '24

Amazing non-argument to what I said! Ultrasound is supposed to do what the physician orders. That means…gasp, you don’t have to lie to them! It’s their choice to not do their job and get in trouble for it. I don’t know why this is such a difficult concept for you big brains.

4

u/D15c0untMD Jul 21 '24

Gwtting them in trouble is not the outcome i want, i want my patient to get their diagnosis.

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u/KumaraDosha Jul 21 '24

And since the tech will get in trouble for not coming in to get your patient their diagnosis, it won’t happen again. OR if they know they will get in trouble, they will come in. This is becoming a Twilight Zone episode where docs suddenly have no critical thinking skills.

1

u/D15c0untMD Jul 21 '24

Look, i‘ve been in this situation. It doesn’t change. We have pleaded, we have reported, we have had meetings. It does not change.

1

u/4883Y_ BSRT(R)(CT) Jul 21 '24 edited Jul 21 '24

That isn’t our fault though. We still have to do what we’re told. We’re not gatekeeping. We have to follow the policies. If we overstep those policies, we get written up or lose our jobs. This is literally all I’ve been saying on this thread and repeatedly have gotten downvoted into oblivion. I even posted my own facility’s protocol. I don’t know why I wasted my time.

The constant disrespect and being caught in the middle has really made me regret getting into this field at all. This is another reason why there’s such a shortage of us. (Not that anyone here gives a shit, but when they have to wait two hours longer for an imaging study due to being short staffed, or have to divert due to the lack of a CT tech, they do.)

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u/KumaraDosha Jul 22 '24

I totally sympathize with your general message and the absurd downvoting. There are tons of situations where our hands are tied by bad policy, and we’re stuck in the middle. We all hate admin.

However, I guarantee no admin would have fussed if the sonographer came in and scanned the testicle. That is their job on call, and I’m 99% sure this was just something the staff have gotten used to, not an official policy, and the sonographer just didn’t want to come in.

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u/4883Y_ BSRT(R)(CT) Jul 22 '24 edited Jul 22 '24

I’ve never argued in favor of the protocol, it was dumb and they should have definitely come in for that. I’ve said it was dumb in multiple comments. I know nothing about ultrasound other than what I was required to call ultrasound techs in for, and no protocol I’ve ever been given has involved how long the patient was in pain. I was always speaking about imaging protocols in general, how we’re required to follow them, and how we’re often caught in the middle of what should be a physician to physician discussion.

I don’t get called in, I’ve worked night shift weekends for 12 years. I’m always just straight up here in the ER scanning (and sometimes covering XR too, depending on the facility). 😂

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u/New_WRX_guy Aug 06 '24

Actually admin might be upset if they had to pay the US tech to come in on call. Radiology admin cares about money not patients. 

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u/KumaraDosha Jul 22 '24

And I’ve been in the opposite situation. Whenever a doc is unhappy with a sonographer, leadership has a stern talking to the tech in question and basically tells them, “Do what they say; they’re never wrong.” (First part is fair; no idea why they have to show their delulu with the second part.) Then things definitely change in the doctor’s favor.

And since this “12 hour protocol” is DEFINITELY not an official admin stance… Yeah, duh, they’re going to nip this in the bud. I don’t know why docs on here think admin has any respect or value for sonographers, vs. the amount of sway physicians have. 😂

0

u/D15c0untMD Jul 22 '24

With us it‘s „we do whatever techs or nurses say because we are shortstaffed already and can’t risk anyone quitting. Residents on the other hand…“.

-13

u/4883Y_ BSRT(R)(CT) Jul 21 '24 edited Jul 21 '24

You realize we follow the protocols created by radiologists, who are also physicians, correct? I’m certainly not advocating for this dumbass protocol. I’m not even an US tech. I’m just saying every imaging tech everywhere, at least in the US, is required to abide by the protocols set by the radiologist group. We have zero part in those decisions.

If the radiologist tells me not to do something, I’m sure as shit not going to do it. They absolutely make the final call.

25

u/POSVT Jul 21 '24

Physician who has seen and evaluated the patient outranks Physician who has not seen and evaluated the patient. And definitely outranks general protocol of a department with questionable relevance to any particular individual patient.

If the radiologists want to deny imaging then they need to be putting their name in the chart with their medical decision making and recommendations.

-15

u/4883Y_ BSRT(R)(CT) Jul 21 '24 edited Jul 21 '24

That’s just not how it works though (and I’m not saying this like it’s my opinion, that this is the way it should be, that one way is more correct than the other, or anything like that, it’s just the way health systems have designed our jobs and the structure of things in imaging, at least the way I’ve seen them laid out in various health systems over the past decade). I’m telling you literally what our management tells us to do, at least anywhere in the US. This is our job. We have to follow those protocols. If you wanted something outside of those protocols, I would give you the number for the radiologist. It simply isn’t our decision to make. If the radiologist approves it, we would do it.

Like I said in another comment, I’m not advocating for the dumbass protocol in the original post. I’m not even an ultrasound tech. I’m just explaining the workflow and what happens if something is ordered in imaging, as a whole, outside of the set protocols.

I am not a radiologist. I am not a physician. I am not admin. I do not make these decisions. You are arguing with the wrong people.

It’s ridiculous that we get shit on for simply doing what we’re told by the people who sign our paychecks. Talk to the people higher up on the totem pole who are actually making the decisions. Bring this up on r/radiology and they’ll tell you the same thing.

I’m being downvoted for being 100% neutral, 100% respectful, and stating facts about how the majority of imaging departments function. I’m not debating anything with anyone. Wild.

2

u/POSVT Jul 21 '24

It is how it works. That's the hierarchy.

That it isn't constantly and mercilessly enforced doesn't make it any less true.

It's not your fault as the tech but both you and your bosses are outranked. That's just the way it is - and the reason that there's not really ever any actual resistance when the word from the ordering doc is "yes I still want it done" unless it's so wildly unreasonable a middle schooler could see it.

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u/4883Y_ BSRT(R)(CT) Jul 21 '24 edited Jul 21 '24

I understand. I really do. And I’m the first person to call the rad and say, “Hey, they’re really concerned about _____ but their _____ is _____. Is that okay?” And usually they’re totally fine with it! I just don’t like seeing some of my fellow techs getting chewed out over doing what they’re told/whatever protocols are in place. We want what’s best for the patient too.

And some facilities I’ve been to have had some truly bizarre and nonsensical protocols.

Edit - This is absolutely hilarious but it’s the end of my shift and I just realized there’s an “Ultrasound Call-In Criteria” paper on the counter. Took a picture for anyone interested! (I have no part in calling them in at this facility and had no idea what they were, literally just happened to be on the counter.) 💀

1

u/New_WRX_guy Aug 06 '24

You’re being downvoted because someone who think they’re on a higher pedastal can’t handle the truth. The ED physician has no more authority over telling a Radiology tech what to do than the Radiologist has over telling an ED nurse what to do.  

 It’s no different than a surgeon refusing to operate on a patient who isn’t a viable surgical candidate despite pushback from another service. The Radiologist ultimately decides if a Radiology study gets performed because they are responsible for reading it.