>The technician just had me hold my breath while she put some jelly on my abdomen and moved the device around. Once in a while she would take ultrasound pictures. Snap, snap, move, breath, snap.

Well, yes, and she probably went to school for quite some time to know exactly what gets a picture and what doesn't.

This is like saying "I had an appendectomy, and all the surgeon did was make some cuts an sew me up." You're not going to a surgeon because he owns a scalpel.

This is not a good comparison. The GP has the technician do the imaging, but the real problem is not so much getting the image, but interpreting what's on it. This is a skill that the GP has to have either way.

The GP surely has the skills to take and read the scan.

But it's not efficient use of their time.

Ultrasound techs do the imaging/take the photos, and the physician reviews them. Ultrasound techs make less money than physicians, that's why physicians are taken out of that part of the process.

It's like saying "The dentist should also clean my teeth". Well their time is better spent on procedures, leave the cleaning to the hygienist.

In the outpatient setting it might take days or a week or more to get an appointment for a formal US, then more time for the radiologist to read it, then more time for the GP to get the results and consider treatment changes then more time to get in touch With the patient. But if I as a physician perform and interpret the ultrasound in real time I can immediately begin appropriate therapy. This is the major benefit of point-of-care US as opposed to conventional US.

The issue of specialist departments seems to be a global problem. A friend of mine needed to get an image taken for a diagnosis. He was referred to another hospital because our local one didn't have the capability. In the end they used an SLR to take a photo and sent it to where it needed to go. Why couldn't they do that in the first hospital? Why can't the GP do that and send the image? I have no idea.

We're constantly led to believe that the revolution is coming where you can snap a photo of your arm, send it to the health service and get a diganosis. That's not happening for a long time, I think.

> “And saving those images is required to bill for the scan,” he notes.

If that throwaway comment doesn't worry people, then I don't know what does. I can understand low resolution, health risks, but a principle barrier to the hospital is that they can't charge you for using it? Fuck that system, quite frankly.

Yeah, that's a really dispiriting sentiment to read.

But the good news is that it's rooted in the hopefully-soon-to-be-obsolete pricing model. If ultrasound devices really can get down into the $2000 price range, then the good doctors will buy them as a cost of doing business, and just not bill for the ultrasound readings. Wait a decade or so, and that'll percolate from the good doctors to the rest of the field.

Yes, there are perverse incentives etc. etc., but I know a number of doctors who are in it for the love of medicine and helping people. The bureaucracy changes course slowly, but those leaders can and do make a difference over time.

One voice does not equal the system, but in any the push by some to bill for clinician performed US is largely driven by a need to generate funds to justify to administrators the purchase of a $70k device.

If the GP had the device, it would have taken them as long as the sonographer (or longer) to acquire the same high-quality images. In fact, it's so impractical for physicians in the US to routinely do their own ultrasounds that they hire sonographers to acquire those images. I don't think this device would have changed your experience, I'm sorry to say.

It appears there are courses just for physicians. [0] Also, the device itself may include a course of some sort. Without evidence, I find it hard to believe GPs aren't capable enough to use an ultrasound device.

[0] https://sonosim.com/who-we-train/

My wife is in med school so I have a bit more familiarity with the subject than the average person.

GP's being capable enough isn't the issue. It's much like blood draws.

GP's are more than capable of drawing blood an sending it off to a lab, but that process requires significant support of outsides parties. It simply doesn't make sense for the GP to take care of it in house when they'll likely need to send it out to someone else.

In the care of ultrasound, it also introduces an issue of "certifying" results. Taking an ultrasound isn't hard, but reading it can be difficult. Even if a GP can read an ultrasound with 90% accuracy, it's still much lower than someone who specializes in reading digital imagery. Of the 90% that a GP can read accurately, how many of those can a GP read confidently? Certainly not 90%. At that point, they might as well send you to someone who will get it right the first time.

In house labs are advertised as profit centers for doctor practices:

http://www.physicianspractice.com/blog/three-good-reasons-of...

By consulting companies trying to sell their services. Take that article with a grain of salt.

In my reply to you, I'm assuming that your GP is 100% capable of performing an ultrasound. Ultrasounds take a well-trained human being a long time to acquire.

The funding model in the US means that providers have all sorts of incentives to pay people other than doctors lots of money to help them maximize patient volume.

(I say providers above because doctors are often just part of the machine, but the machine doesn't want to waste the doctor's valuable time any more than an independent doctor does)

From a provider standpoint, however: If they are not technically adept at operating an ultrasound machine, and do not have the knowledge necessary to read an ultrasound, why spend $2,000? And on that note, is this device able to be billed for in order to recoup that cost? We have that problem right now with OCT-A in ophthalmology practices, where the technology exists and is FDA approved but cannot be billed for to recoup the costs of the hardware.

Yup, doctors specialize. When a GP gets orders a scan, such as a CT or x-rays, it's typically another doctor that specializes in the imaging area who examines it and writes a report. I don't think many GPs would have much of a use for an ultrasound because they would prefer a specialist perform it.

A few caveats. One, telepresence. You can have the specialist basically be there with you as you operate the probe. Everything gets done in office and the patient doesn't have to travel which can be a big deal in rural communities. I find most urban GPs don't even have a second thought about sending patients off for a scan at some other office.

Following that would be very remote doctors, those that might be labeled as a GP, but basically have to have a ton of specialist knowledge because of the wide range of things they might need to do.

And of course vets, especially large animal vets. Who are already using cool devices such as head mounted displays to view the ultrasound as they generally have their arm all the all the way up an animals rear end.

Hadn't thought about rural physicians, very good point. I come from a relatively rural community, but with a large hospital and specialist presence, so it kind of slipped my mind that there are even smaller communities that would benefit from this.

Telepresence sounds great in theory, but in practice telling anyone, even a physician with a great deal of anatomical knowledge, how to use an ultrasound probe can be frustrating at best.

Also did not know about vets using these new devices, very interesting!

I'd love a push for more monitoring capacity in the form of cheaper non invasive medical tools.

One of the main health issue is waiting to fix an issue. Cost and exam delay are both factors into letting things sink deeper.

Also, lots of medical tech is IMO (feel free to take me down on this one) stuck into analog electronics and physics of the past[1]. Namely one way information live flow. Today we may be able to compensate through software logic. Think super resolution algorithms used in space exploration. Now just think how neat it would be to make use of these smartphone GPUs for once .

[1] don't get me wrong, they did breathtaking thinking most of the time, but it's a difficult art and not necessarily the best solution today.

So just as I needed reassurance this pops up https://news.ycombinator.com/item?id=15595269

timely :)