vaginapagina | Uterus sonogram without consent: I need advice

Uterus sonogram without consent: I need advice

Hi,

when I took a sonogram for digestive problems, I ended up getting my womb checked, I felt it was wrong but also confused and embarrased so I didn"t say anything.

What do you think?

Last year I took a sonogram for digestive problems (liver and gall bladder), a woman performed it on my upper abdomen, told me she was also looking at my kidneys, I was fine with that, exam done.

This year I took the same exam with a different person: an older man, very efficient, the exam was done in a couple of minutes, he was moving the transducer around and taking pictures really fast.

I told him I had gall bladder problems, he did the area, then my kidneys, and lastly he said "problems with reproductive organs?..." and before I could answer, slid the "mouse" from my stomach to my uterus and looked for a couple of seconds.

It happened so fast, I didn't say anything because I was asking myself " is this normal? should I be okay with that?" but I was really uncomfortable and I keep thinking about it.

My first question: is it normal practice when getting a sonogram to have more organs checked than what is prescribed?

My second question: how would you tell the person that this is not okay with you and ask them to stop?

Flat | Top-Level Comments Only

No it is not normal practice, unless to person performing the sonogram or the doctor reading the results and sending the report to the ordering doctor feels like there is good reason to do it currently rather than having you come back later. ETA: They should always discuss extra imaging with you first, & give you the option of waiting for a discussion with your doctor before just proceeding on with it.

In regards to your second question, I would say "I would like you to stop now, this is not what I am here for & I am uncomfortable with this." They should stop IMMEDIATELY.

Personally, I would call & complain to the staff supervisor because that's not what you were there for. Also explain that you do not expect to be held responsible for payment of the extra imaging done because it not necessary & you didn't want it done in the first place.

Edited 2010-11-27 19:58 (UTC)

(deleted comment)

good intentions don't invalidate the discomfort it could have caused.

I don't have a lot of experience with what's standard in terms of ultrasounds. However, I know that every time I've had it done as a patient, both the doctor/NP (at the initial appointment) and the ultrasound tech (immediately prior to the ultrasound) have gone over the procedure before any undressing or imaging had taken place. There have been times when they've taken images of other organs (e.g., imaging the bladder in addition to the uterus and ovaries) that didn't seem directly related to the suspected problem -- but I always knew about that in advance.

I went in for an ultrasound for what I though was a gallbladder issue and once the woman did my abdomen she stepped ou and said she would be right back. She had seen something else concerning and called my doctor who approved an additional transvaginal ultrasound. The tech could tell me anything but she just said that the doctor had needed another angle of my abdomen and I thought that was weird but I just wanted to know what was wrong with ms.

It ended up being a 17cm growth on my ovary.

In your case, I'd call and speak to a supervisor about your feelings/the techs behavior.

This is normal practice, in Ontario at least. I've had several abdominal and pelvic ultrasounds related to kidneys and colon. When you go in for an u/s, you don't pick and choose what organs you want examined unless the doctor who ordered the test has made the referral explicitly clear, which is rare. If it's digestive, it's abdominal - upper and lower.

The only time you'd be asked for consent is when the tech uses the transvaginal wand for a pelvic u/s.

Generally in the US there are certain diagnosis & CPT codes they use which is what determines the images taken. Regardless, you should always have procedures explained to you & you should always be asked for consent because it could make a patient very uncomfortable if they think they came in for certain imaging. obviously she went in for digestive problems, not for problems with her reproductive organs. there really was no reason for him to do that imaging without asking her consent or explaining why to her first.

You're giving your consent when you agree to have an "abdominal" or "pelvic" ultrasound. And furthermore, a reproductive problem can feel like a digestive issue; vice versa.

In Canada, doctor's offices don't have ultrasound machines. You see your doctor about a concern and then you're referred for imaging at a later date by a technician. That technician may not even know what the medical concern is. S/he just explores the areas ordered in the requisition.

Perhaps that's the main difference. If my doctor had easy access to this sort of equipment, i can see him examining a specific organ. The one i'm complaining about. I wouldn't expect him to look at my uterus if i'm saying my stomach hurts, without letting me know first.

I don't believe that. I believe that every procedure should be explained to you & consented to before being performed. I am fully aware problems caused by one thing can be caused by other things, but if she has a history of gall bladder & other digestive issues, then only those organs should be looked at at that time as ordered by her physician (which, assuming from her shock that is what was ordered). It would then be up to her doctor to discuss having her reproductive organs examined & additional images taken should nothing be found. We are also referred out to an imaging center, an ultrasound is typically not done in office unless it's for pregnancy, & our requisition's include all CPT & diagnosis codes.

This type of spontaneous imaging could also be a problem with insurance, because imaging done on the reproductive organs sometimes (honestly, in my experience in health care, MOST times) requires prior-authorization by the insurance company. Without it, she could become responsible for the full cost of the procedure since it was not authorized.

Also, if her physician wanted them to examine her reproductive organs he should have discussed it with her before send her over to the imaging center.

That's interesting. I never would've thought of this in terms of cost. I got the feeling that it was more of a violation of privacy. As in, how dare you look at my internal privates?!? I guess it should have been explained that the u/s will include looking at x, y and z. In my experience, i understood that a lower/upper abdominal u/s included looking at everything in those areas.

So in terms of private insurance, do you pay by the image? Or by the organ? Or time taken? I suppose i take for granted that this stuff is covered here. i go in, they take a half hour to look at everything, and there's no going back to see if maybe it's this or that causing the problem.

Well, I'm sure it was more her violation of privacy & the fact that she was unaware he was going to take images of that particular area.

You pay by the procedure, and scans/imaging of areas have different CPT and diagnosis codes. The codes are what determines what images are taken & also what is covered/not covered &/or requires authorization by your insurance company.

Not many patients have any clue about that, but I work for an OB/GYN office & often when these things are tacked onto a sonogram (which sometimes changes the diagnosis) it is HELL for us to get it authorized. I've had them do a mammogram on a patient, and then do a breast u/s because of something they saw. Mammograms never need authorization but with certain insurances the u/s does. Now this doctor has gone ahead and had the technician do it & WE are the ones who have to get it authorized. It's a pain in the behind!

Edited 2010-11-27 23:07 (UTC)

You use the word "should" a lot. Perhaps many things SHOULD happen but they routinely do not. I have two major medical issues and I never know what I'm going in for until I look it up online or ask when I'm there. No one tells you anything unless you are asked. :/

I guess I just work with some really amazing doctor's who truly believe in quality health care. They never let a patient go into something not understanding what they are looking for or is going to be done in a procedure. I do say "should" a lot, because it really should happen that way.

Don't ever be afraid to ask your physician questions like what they are specifically sending you for, what you need to expect, & what is being looked for. It really bothers me when patients have to constantly ask questions & they get the run around. You shouldn't have to be worried or wondering what's normal.

I was fourteen when I got sent for a transvaginal ultrasound, & that particular GYN was lousy. I was FOURTEEN, & all she told me & my mom was that I was having an ultrasound done to view my ovaries. I'm thinking sticky gel on my belly and images on a computer screen. When I got to the imaging center & the tech asked me if I was sexually active I asked why she needed to know & when she told me I just about died. Our hospital has a policy of not doing transvaginal unless the patient is sexually active or over 18 & consenting. I have never seen that doctor again & my doctor now (who I work for) explains anything & everything because he knows I will just ask a million questions.

That's my experience in New Jersey as well. The tech had nothing to do with the doctor that ordered it. The slip simply said pelvic and abdominal ultrasound and they took pictures of everything both times (and this included transvaginally).

I would say something like, "Um, I know you're probably trying to be helpful, but I feel uncomfortable with this. Please only perform the sonogram on the parts of me we're here to discuss."

I can only really answer your first question, and offer sympathies for your having had a bad experience. In terms of the practicalities, a sonogram picks up whatever is in its field; thus, it's difficult or impossible to get a sonogram of only a kidney, for example. In terms of consent and procedure, an abdominal sonogram can include non-digestive organs in the abdomen, but absent the fine print of your specific consent form, I couldn't say for sure.

When I've ordered abdominal ultrasounds on kids and teens, the order form has given me a choice between "right upper quadrant" which covers the liver and gallbladder, "renal/bladder" which is kidneys and bladder and "complete abdominal" which covers the liver, gallbladder, kidneys, bladder, ovaries, uterus and pretty much everything else in there. I've made the choice based on what I was looking for - just liver problems versus abdominal pain that could come from multiple places.

So it's possible that the first doctor ordered specifically a right upper quadrant ultrasound, while the second one ordered a complete abdominal ultrasound, in which case each tech was doing as ordered. In that case, it would depend on the order which is something to discuss with the doctor.

It's also possible that the tech was looking at more things than the order stated, in which case it is something to discuss with the tech or his supervisor. I agree that a tech should not image organs outside of what the order states, for privacy, consent and billing reasons. However, without knowing what the specific order stated, it's impossible to know if that's what happened. Regardless, you do have the right to say "no" and "stop" at any time you are uncomfortable. It's your body.

This. I've had region-specific abdominal scans, and more general ones, depending on my symptoms.

The two times I had a sonogram, it was done pretty much everywhere. I figure they think once they're taking pictures, they may as well photograph everything just in case. If you are uncomfortable with anything though, just speak up. They're certainly not allowed to do anything you say you don't want.

i was sent for an abdominal ultrasound due to gallblader issues and during one of those they discovered that i had an ovarian cyst
sometimes when they are looking around they come across things that were not expected and end up looking around there too, i think that is probably what happened with you as well
that being said, if you are uncomfortable at any time with whatever is happening you should be able to tell the tech. to explain to you what is happening and why and if you still feel uncomfortable to have him/her stop the exam

I guess the moral here is to ask exactly what they are going to do before you let them near you. This is a tactic that has worked really well for me in the past - although it has upset some consultants when I disagreed with what he thought he was going to do and walked out. Ultimately it's your body.

Now, I once had an ultrasound of my bladder and the woman was commenting on my ovaries (a follicle was rupturing so it was kind of nice to know that everything was working the way it should). I guess technically she maybe shouldn't have been looking but to be honest, it really didn't bother me. If she'd tried to do a pelvic exam or an internal scan then I would have had an issue but if someone wants a quick squint at my reproductive organs with an ultrasound I don't have a problem with it.

The issue here is finding out your comfort level. You now know that you are uncomfortable with unnecessary womb-scanning so, if you're ever in the situation where it might happen again, you make sure it doesn't happen. If there's a good reason for it happening then the doc/technician can discuss it with you then.

I personally don't let dentists go near my mouth without knowing exactly what they are planning and why. Last time I was there, the dentist defended his treatment decision by showing me my XRay and explaining what it meant. In general, health professionals (and car mechanics) like you taking an interest and are more than happy to show you what's going on and discuss it.

And also, if he was only looking at your gall bladder/liver then he shouldn't have been near your kidneys. It sounds like he was doing a general abdominal (all quadrants) exam.

I'm in Canada and it's common practice here to check other organs. A tech explained to me its partly so they can check any abnormalities seen are not equitment mess-ups, and partly because in the case of abdominal pain or problems, it can be things like cysts on the uterus or ovaries triggering it. Or what feels like ovary pain can be a kidney issue. The way he asks sounds like he might of seen something abnormal in that area and checked it out.

I am pretty sure when I went in for kidney problems they checked out my uterus and other things as well. I remember my uterus though because it was the first time I had seen my IUD, and it was so bright and white looking. It didn't make me uncomfortable so I didn't give it another thought. My reasoning is that if they are already there why not give it a check out? I know from experience that where something hurts doesn't mean that is where the problem is (My right ovary side ALWAYS hurts, even though half the time the cysts are on the left!).

Every time I've had a pregnancy-related ultrasound (including one for some vaginal bleeding, where they only needed to check the placenta, basically), they've checked other organs (kidneys specifically), so for me personally, I wouldn't be surprised if I went in for a kidney ultrasound and they checked my uterus.

Flat | Top-Level Comments Only

Uterus sonogram without consent: I need advice

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