Uterus sonogram without consent: I need advice

[amanda99266.livejournal.com]

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?

Comments

[kurishii.livejournal.com]

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.

[brittmarie.livejournal.com]

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.

[kurishii.livejournal.com]

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.

[brittmarie.livejournal.com]

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.

[kurishii.livejournal.com]

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.

[brittmarie.livejournal.com]

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!

[cailin-t.livejournal.com]

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. :/

[brittmarie.livejournal.com]

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.

[cailin-t.livejournal.com]

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).