I work with a doc that respects my time. He gives me history. Many times he only sees the patient briefly in the hospital or talks with the referring MD. The Pre hemo patients often get ultrasounds before the consultation, most though do get a consult before. On the vein patient, all get consults before the ultrasound. Arterials, again, depends on the referral. Teamwork is a necessity in all offices. We have "rules" but they are bendable depending on the circumstances. I think with pre hemos, the patient has to want a fistula. We have patients that get referred and just say, I want to go my way, and that it ok.
Have a great day all, continue to be the "detectives of disease" and be willing to ask the questions.
Lisa
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Sent: Tuesday, November 12, 2019 21:00 PM
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Subject: UVMFLOWNET Digest - 4 Nov 2019 to 12 Nov 2019 (#2019-129)
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There are 5 messages totaling 407 lines in this issue.
Topics of the day:
1. May-Thurner Syndrome
2. performing US prior to MD consultation (4)
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Date: Tue, 12 Nov 2019 15:57:54 -0500
From: Harvey Wilson <[log in to unmask]>
Subject: Re: May-Thurner Syndrome
Hi,
Consider the rare Left sided IVC and corresponding Iliac variants that can compress the Rt side!
cheers,
Harvey Wilson RDMS RDCS RVT
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Date: Tue, 12 Nov 2019 20:16:22 -0500
From: Sandra Urrea <[log in to unmask]>
Subject: performing US prior to MD consultation
Hi everyone,
I would like to get your thoughts regarding performing US studies on new patients prior to MD consultation. Let me give an example: The Nephrologist refers a patient to the Vascular Surgeon for consultation, a vein mapping is performed prior to the visit. Are there any legal implications doing this? I would think the right thing to do would be to have the patient see the doctor first then he/she will order the ultrasound. Shouldn’t be treated any differently than prescribing a medication or ordering a CT or any other test.
And, Is there any article or paper to support this topic?
Thank you in advance for your help.
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Date: Tue, 12 Nov 2019 20:41:39 -0500
From: Ann Marie Kupinski <[log in to unmask]>
Subject: Re: performing US prior to MD consultation
HI,
I don't have any specific paper that deals with whether the patient sees the doctor first or gets an ultrasound first. However, I routinely scan patients before they see the surgeon exactly for the example you mention.
These patients are referred to the access surgeon for possible AVF placement. The only way the surgeon can make that decision is with the ultrasound findings. If we did it the other way around, the patient would have to see the doc , then get the ultrasound and then see the doc again.
If I have a patient that questions why they see me first, I explain the info is needed to know completely what options exist for the patient. They are always ok with that explanation.
Other examples would also work - for instance a patient referred for a bruit. The carotid ultrasound is performed first and then the doc reads the results to determine if the bruit is from the carotid. As long as there is an appropriate indication and there is an intent to treat or diagnose the source of a symptom, then I think you are legally ok. But - I am not a legal expert.
Ann Marie
On Tue, Nov 12, 2019 at 8:16 PM Sandra Urrea < [log in to unmask]> wrote:
> Hi everyone,
>
> I would like to get your thoughts regarding performing US studies on
> new patients prior to MD consultation. Let me give an example: The
> Nephrologist refers a patient to the Vascular Surgeon for
> consultation, a vein mapping is performed prior to the visit. Are
> there any legal implications doing this? I would think the right thing
> to do would be to have the patient see the doctor first then he/she
> will order the ultrasound. Shouldn’t be treated any differently than
> prescribing a medication or ordering a CT or any other test.
> And, Is there any article or paper to support this topic?
>
> Thank you in advance for your help.
> To unsubscribe or search other topics on UVM Flownet link to:
> https://urldefense.proofpoint.com/v2/url?u=http-3A__list.uvm.edu_archi
> ves_uvmflownet.html&d=DwIFaQ&c=bvhoC4tmqmsyJXm4a1uTSQ&r=Cylf6m-A10s-m3
> zvFZy_Q6S_tm90gdvXNWWw_nm3eXU&m=T_uXnUV6Lk5pOeus2s25D1-fZhYaNgS6q8wG1h
> ZYX-4&s=QXCHWXjZRvyZd87MLtAnl0YvbetDrvHrGyLoIIZByU0&e=
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------------------------------
Date: Wed, 13 Nov 2019 02:06:45 +0000
From: Norman Paley <[log in to unmask]>
Subject: Re: performing US prior to MD consultation
If the nephrologist is a duly licensed practitioner there should be no reason why they cannot order a vein mapping, or any other vascular laboratory study, for that matter. It doesn't have to be ordered by a vascular surgeon. Whether or not the nephrologist is making a referral to a vascular surgeon, if they order the vein mapping study, then there is no reason why it should not be performed. If they didn't order the study, then I don't think it should be done, even if the patient is being referred to a vascular surgeon.
Norman Paley, BS, RVTStaten Island, New York
-----Original Message-----
From: Sandra Urrea <[log in to unmask]>
To: UVMFLOWNET <[log in to unmask]>
Sent: Tue, Nov 12, 2019 8:16 pm
Subject: performing US prior to MD consultation
Hi everyone,
I would like to get your thoughts regarding performing US studies on new patients prior to MD consultation. Let me give an example: The Nephrologist refers a patient to the Vascular Surgeon for consultation, a vein mapping is performed prior to the visit. Are there any legal implications doing this? I would think the right thing to do would be to have the patient see the doctor first then he/she will order the ultrasound. Shouldn’t be treated any differently than prescribing a medication or ordering a CT or any other test. And, Is there any article or paper to support this topic?
Thank you in advance for your help.To unsubscribe or search other topics on UVM Flownet link to:https://urldefense.proofpoint.com/v2/url?u=http-3A__list.uvm.edu_archives_uvmflownet.html&d=DwIFaQ&c=bvhoC4tmqmsyJXm4a1uTSQ&r=Cylf6m-A10s-m3zvFZy_Q6S_tm90gdvXNWWw_nm3eXU&m=T_uXnUV6Lk5pOeus2s25D1-fZhYaNgS6q8wG1hZYX-4&s=QXCHWXjZRvyZd87MLtAnl0YvbetDrvHrGyLoIIZByU0&e=
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------------------------------
Date: Tue, 12 Nov 2019 21:22:54 -0500
From: vasc1 <[log in to unmask]>
Subject: Re: performing US prior to MD consultation
Verbal.order is fine as well.As long as its documented Dr Jason [log in to unmask](M) 954-801-2496
-------- Original message --------From: Norman Paley <[log in to unmask]> Date: 11/12/19 9:06 PM (GMT-05:00) To: [log in to unmask] Subject: Re: performing US prior to MD consultation
If the nephrologist is a duly licensed practitioner there should be no reason why they cannot order a vein mapping, or any other vascular laboratory study, for that matter. It doesn't have to be ordered by a vascular surgeon. Whether or not the nephrologist is making a referral to a vascular surgeon, if they order the vein mapping study, then there is no reason why it should not be performed. If they didn't order the study, then I don't think it should be done, even if the patient is being referred to a vascular surgeon.
Norman Paley, BS, RVT
Staten Island, New York
-----Original Message-----
From: Sandra Urrea <[log in to unmask]>
To: UVMFLOWNET <[log in to unmask]>
Sent: Tue, Nov 12, 2019 8:16 pm
Subject: performing US prior to MD consultation
Hi everyone,
I would like to get your thoughts regarding performing US studies on new patients prior to MD consultation. Let me give an example: The Nephrologist refers a patient to the Vascular Surgeon for consultation, a vein mapping is performed prior to the visit. Are there any legal implications doing this? I would think the right thing to do would be to have the patient see the doctor first then he/she will order the ultrasound. Shouldn’t be treated any differently than prescribing a medication or ordering a CT or any other test.
And, Is there any article or paper to support this topic?
Thank you in advance for your help.
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End of UVMFLOWNET Digest - 4 Nov 2019 to 12 Nov 2019 (#2019-129)
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