Larry Istrail, author of the POCUS Manifesto, discusses the integration of point of care ultrasound in physical exams and its benefits. They explore the debate on whether it should be an independent diagnostic modality or integrated into the physical exam. They also address misconceptions about Pocus, its relationship to the physical exam, and its impact on patient care, including the non-invasive measurement of right atrial pressure.
Point of care ultrasound (Pocus) brings physicians back to the bedside and enhances shared decision making, improving patient care.
Integrating Pocus into the physical exam provides clinicians with more accurate and timely information, enhancing patient care.
Deep dives
The interplay between physical exam and point of care ultrasound
The podcast explores the relationship between physical examination and point of care ultrasound (Pocus) in evaluating patients. Pocus is not outsourced to a radiologist, but rather performed by physicians in close proximity to patients. Patients undergoing Pocus reported overwhelmingly positive experiences, feeling that physicians took them more seriously and provided a more thorough examination. Pocus is seen as a tool that brings physicians back to the bedside and enhances shared decision making.
Integrating Pocus with the physical exam and its billing implications
There is debate about whether Pocus should be integrated into the physical exam or maintained as a separate diagnostic modality. Some argue for separate billing and documentation, while others see Pocus findings as part of the physical exam. The flexibility exists to record Pocus images and findings alongside traditional physical exam documentation. Regardless of the semantics, the use of Pocus provides better clinical information and time spent with patients, leading to improved patient care.
Exploring the impact of Pocus on physical exam skills and patient care
Critics suggest that Pocus leads to the degradation of physical exam skills, similar to how technology impacts other skills over time. However, historical examples like the stethoscope's introduction show that embracing advancements ultimately benefits patient care. The objective data obtained with Pocus is a valuable addition to the diagnostic process. While it remains a challenge to study the direct impact of Pocus on patient outcomes, there is evidence showcasing its benefits in areas such as time to pericardiocentesis and volume status assessment. Overall, integrating Pocus enhances patient care, providing clinicians with more accurate and timely information.
Part 2 of this Special Edition episode with Larry Istrail, author of the POCUS Manifesto. More great talk about POCUS, the physical exam, and ultrasound research.
https://www.ultrasoundgel.org/131
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