Interlude: A way to look at the role of ultrasound

John Knowles, presidential adviser and head of Massachusetts General Hospital (when I was a lowly serf there) told me some 30+ years ago that it's a lot easier to prevent disease than to treat it. I treasure the memory of the interaction, although he might have been stingier with his prescient platitudes if he knew that I would soon deviate from my original interest Cardiology.

What I have seen over and over again is that a lot of people are reluctant to have diagnostic exams and how relieved they are when there is a simple, fixable explanation (like pelvic adhesions in a woman afraid of ovarian cancer) or, better, yet, when they exam can show that something really appears to be normal.This is, actually, the main role of ultrasound in obstetrics. There is always maternal anxienty, it gets worse with each pregnancy, typically least first time around and peaking with the third child, eventhough some 90+ % of unselected groups of pregnant women traversing the first trimester in peace, will have 'normal' children close to term.

The great developmental pediatrician HFR Prechtl in a massive body of work, slipped in a paper maybe 15 years ago about  scoring 'wellness' in exams rather than abnormalities.I recall his referring to that as 'optimality testing'. There have been lots of  studies with  'quality of life' as an end point, which is very closely related  and which also provide a set of statistical tools for coping with this type of subjective variable.

I think it is about time that we all got involved in studies which show how a lot of our exams promote patient happiness by eliminating the worries about specific problems. In many ways this is an unique property of ultrasound, which can be used widely, cheaply, and without any compromise in patient safety. In places where ultrasound is trusted, there is also reduced demand upon and improved utilization of CT and MRI, but that is another matter entirely. The tools are there, and after focusing on pathology for so long, a look at the flip side might be refreshing. If you think about it, a negative exam is even better for prevention than finding an early indication of a problem requiring some behavioral modification of pre-emptive drug therapy.