When I had my graduate and postgraduate medical education (on the East Coast mid 1960's-1970's) there was NO public medical advertising, and the rare times when anyone sought to advertise, the assumption was that physician, clinic, or hospital had to be failing financially, probably, because they weren't very good at what they did. In the 1980's, some of the larger hospitals that were failing financially, began to advertise heavily on radio, TV, magazines, and newspapers trying to capture new patient visits or referrals for their extended professional resources. For some places, that worked very well and has become established now as part of the daily background. In some practice areas, like infertility, back pain, and anything cosmetic, smaller clinics and even private practitioners allocate a lot of funds for local promotions.
This new blog was prompted by an ad that I heard today while waiting for a news updates on Libya and Japan. It was from a larger, specialized medical group that kept going on about the latest and most advanced TECHNOLOGY, which was why patients should just flock to them. I have to say that I'm a little tired of every place claiming this distinction. And as a Radiologist, I tend to chuckle at how all visual ads, like TV or brochures, always seem to have some mandatory MRI ( or, the much older, CT) images to illustrate the claim. What I think rankles most is that it is the skill and experience of the users of the TECHNOLOGY that need to be 'best' for this all to work, nor is there any way for individual patients to really know about this when they are trying to decide where to go for a test or procedure. Most people rely on their primary doctor to select where a test ought to be done and that person may be limited to the self interest of their own institution or network.
I have been subspecialized in ultrasound, essentially since the field began here in the US. So, I've kind of seen it all. I am very proud of the technical advances that have been almost continuous during that time, and I have even had a little to do with some of those improvements myself. There was a big jump in equipment performance in 1983 with the commercial release of Computed Sonography - more about that in later posts. It ushered in what I think of as the golden age of Ultrasound, because there was a relatively small group of ultrasound physician specialists who were trying to find out how this method could be best utilized medically on its own and relative to all other diagnostic tools.
Computed sonography began what I might refer to as the beam former approach to image reconstruction. The end point was that images had less noise than earlier kinds of equipment: diagnoses were broader, faster, and more reliable than ever before in all applications.
As computing capabilities became faster (and cheaper) beam former technology and its partner, transducer design, improved, and many manufacturers began to produce lower cost equipment, although with performance features and clinical utility were typically inferior to what might be achieved with the "best" equipment used expertly. All it might take to avail oneself of ultrasound in a practice, would be to buy a unit, buy a technologist to run it, or attend a short training course. This is admirable in a practice 50+ miles from anywhere, but it's a little dubious in urban or suburban areas with lots of local medical resources. Smaller units are often designated as point of care equipment. Most emergency room services have point of care ultrasound devices, and some ER physicians now have fellowship training, although most of the clinical work in this area tends to be focused on limited issues and resembles work of the 1980's. I suppose an emergency facility getting on site ultrasound for the first time can advertise latest technology (for them), meaning newest.
I do realize that facility advertising has everything to do with the facility and essentially really not much to do with the people who work there. I assume, that any physician is always trying to do the best he or she can all of the time. That is an entirely separate issue from using capital equipment purchases promotionally.
Obstetrics is the field which has taken made the most use of point of care ultrasound imaging. The good thing is that a lot of fetuses get looked at who would not have had the opportunity otherwise. The bad thing is that most of those millions of exams annually are with low performance equipment, done by personnel with limited imaging education and restricted clinical goals. Perhaps, because our society tends to indulge in lawsuits, particularly when something appears to go wrong in pregnancy, an unique concept transpired when many Obstetrics facilities wrested this form of imaging from Radiology departments in their institutions which was to identify levels of exam for non-Radiologists, A level I exam is supposed to convey one that is utterly basic, including a short set of mandatory imaging items. Imagine this, for the first time in the history of medicine, practitioners thought that it is OK to request or to do a study that is identified as limited, inexpert, or incomplete in any way. The justification is thrugh admitting that the study not as good or complete as one might get somewhere else. Of course, places doing limited exams cannot usually claim 'latest technology', on the other hand there are many instances of such places promoting their 3D fetal portrait capabilities, eventhoug this does not change the scope of the exam itself.
The intention of this blog is to expand upon the interfaces between patient, examiner, and equipment, unearth some of the trends that have led us to where we are now (definitely not another golden age from the patient's standpoint), and then get into a few of the real technical advances happening now that may revitalize the use of this amazingly powerful diagnostic tool. Maybe, we will get to a point where pointless touting of 'The Latest Technology' will be identified for what it is.
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