Sonographers' communication in obstetrics: Challenges to their professional role and practice in Australia

Patients' requests for radiological imaging: A qualitative study on general practitioners' perspectives

BACKGROUND

With the increasing availability of information, patients are becoming more informed about radiology procedures and requesting imaging studies. This qualitative study aims to explore factors that influence general practitioners' (GPs) decisions to fulfil patient requests for imaging studies during clinical consultation.

METHODS

Semi-structured interviews were conducted with 10 GPs working across five private medical centres in Northwest Sydney. Conventional content analysis was used with emergent themes to identify GPs perspectives.

RESULTS

Six themes stood out from the interviews with GPs fulfilling patient requests for imaging studies. They included four pertaining to patient factors: patient expectations, 'therapeutic scans', 'impressive labels' and entitled. Two further themes pertained to the GP perspective and included defensive medicine, and 'new patients'. Requests are fulfilled from anxious or health-obsessed patients, with GPs worrying about litigation if they refuse. However, GPs decline requests from patients with entitlement attitudes or during first visits.

DISCUSSION

The findings suggest that GPs struggle to balance their responsibilities as gatekeepers of imaging with patients' expectations of request fulfilment. Clear guidelines on the appropriate use of diagnostic imaging and its limitations could help patients understand its proper use and ease anxiety. Additionally, education and training for GPs could help them manage patient expectations and provide appropriate care.

PATIENT CONTRIBUTIONS

Patients, service users, caregivers, people with lived experiences or members of the public were not directly involved in the design, conduct, analysis or interpretation of the study. However, our study was conducted in primary care facilities where the GPs were interviewed about patients' requests for diagnostic imaging based on their own initiatives. GPs' perspectives in managing patient expectations and healthcare utilisation were explored within the Australian Medicare system, where medical imaging and image-guided procedures come at little to no cost to the individual. The study findings contribute to a better understanding of the challenges faced by GPs in dealing with patient consumerism and requests for diagnostic imaging, as well as factors influencing request fulfilment or denial. Insights gained from this study may inform future research about delivering patient-centred care within a similar context.

Role of Transvaginal Sonography in the Diagnosis of Female Infertility: A Comprehensive Review

Female infertility, a complex and emotionally challenging condition, impacts millions of women worldwide. Timely and accurate diagnosis is crucial for tailoring effective solutions to overcome fertility challenges. Transvaginal sonography, a real-time and non-invasive imaging modality, is pivotal in this diagnostic process. This review focuses on the structural abnormalities of the female reproductive system related to female infertility, particularly highlighting the capabilities of transvaginal sonography in assessing ovulatory disorders, structural anomalies, endometrial conditions, ovarian reserve, and other contributing factors. It is important to note that while transvaginal sonography excels in detecting structural abnormalities, it may not effectively identify lifestyle and hormonal changes. This limitation underscores the necessity for a comprehensive diagnostic approach that includes additional modalities to address the multifaceted nature of female infertility. Despite acknowledging the inherent limitations and operator dependence of transvaginal sonography, we emphasize its significance in guiding clinicians toward well-informed decisions and personalized treatment plans. Looking forward, we anticipate the continual evolution of sonographic technology, offering enhanced diagnostic capabilities. The commitment to improving fertility outcomes for individuals and couples navigating the intricate path toward parenthood remains paramount. In conclusion, a holistic diagnostic approach incorporating various modalities is essential for a thorough understanding and effective management of female infertility.

Factors that Influence the Communication of Adverse Findings in Obstetrics: A Survey of Current Sonographer Practices in Australia

Objective:

To identify factors influencing sonographers’ practices in communicating adverse obstetric findings and to understand their views on the need for standardized national policies and guidelines.

Methods:

Qualified and trainee sonographers who currently perform obstetric sonography were invited to complete a survey through the Australasian Sonographers Association. Closed-ended questions sought information on the demographic profile of the participants and their experiences on a range of issues related to workplace practices and policies. Open-ended questions allowed respondents to elaborate on workplace interactions and their views on the communication roles of sonologists (radiologists and obstetricians) and sonographers.

Results:

The practice setting, the background of the sonologist, the type of adverse finding, and the trimester in which a patient is scanned have an impact on the level of difficulty for sonographers in obstetric communication. These findings highlight a lack of uniformity of sonographer and sonologist communication with patients due to limited training, lack of formalized departmental policies, inadequate support, and communication practices by radiologists. As a result, respondents strongly supported the development of a standardized national policy.

Conclusion:

In the current environment of patient-centered care, sonographers are in a challenging position as they do not have policies supporting them as independent health care professionals, autonomously deciding on the best approach to communicate findings with their patients. This may lead to anxiety and stress if they lack control over the interaction. More support from sonologists in a radiology setting is needed. These findings should encourage professional bodies to address these issues by working collaboratively and to recognize the importance of the sonographers’ role and their unique position with pregnant patients.