Ultrasound examination is one of the most popular diagnostic tests ordered by doctors of various speci alties. In the light of the regulations in force in Poland, an ultrasound room can be opened by any doctor. Unfortunately, this translates into the quality of the research. We talk to Prof. dr. hab. n. med. Wiesław Jakubowski.
Ultrasound examination( ultrasound ) allows you to obtain an image of the organs and tissues of the human body. This diagnostic test for treatment was introduced in the 1960s. Conducting the study sounds simple, but it is not. The assessment of the image seen depends not only on whether the patient has properly prepared for the examination and whether the apparatus is operational. First of all, it is important that the doctor who performs the examination is able to properly read and interpret the image seen. It would seem that such an old diagnostic method should be a very precise tool. Unfortunately, we still read about the misdiagnosis of ultrasound. Why is this happening? How to choose a surgery and a specialist so that the test is carried out reliably and shows the truth about the condition of our body? We talk to prof. dr. hab. n. med. Wiesław Jakubowski.
- For over 30 years you have been dealing with ultrasound diagnostics in a practical and scientific way. Has the level of medical services changed over the years?
Prof. Wiesław Jakubowski: In general, yes. This is related to several important elements. Firstly, the requirements of employers and hospital management are higher and higher towards people performing ultrasound examinations, which necessitates the need for continuous training of doctors. Secondly, we have better and better equipment at our disposal. And thirdly, more and more examinations are performed not by general ultrasound specialists, but by specialists. The point is, cardiologists learn how to perform and read ultrasound images to better diagnose and treat heart conditions. The same is true in other areas of medicine, such as orthopedics, ophthalmology and urology.
- And yet fatal mistakes still occur.
W.J .: It's true. According to estimated data, in 2013 up to 15%, and in the case of vascular diagnostics, up to 20% of tests were useless ornot very useful diagnostically. Importantly, the number of false-positive or false-negative tests has sharply decreased. To simplify this statement, it is about tests on the basis of which a disease is diagnosed when it is absent, or it is not diagnosed when there are changes in the organs that are characteristic of it.
- So how do we choose a place and specialist we can trust?
W.J .: First of all, I would advise against performing tests in the first office I come across. First, let's find out what specialization the doctor working in it has and what qualifications he has. The fact that someone is a radiologist or imaging diagnostician does not guarantee that the thyroid or knee examination will be performed properly and interpreted in accordance with medical facts, because doctors are not properly prepared to perform ultrasound as part of their specialization. I can state it on the basis of many years of observations.
- So we have a well-trained doctor, what about the apparatus?
W.J .: For their own safety, the patient should check whether the office is accredited by the Polish Ultrasound Society. This is important because accreditation is given to surgeries that guarantee a good level of staff, a good level of equipment and decent housing and sanitary conditions. For example, if the device has been working for five years, its head must be assessed (tested) at a certification center to be sure that it can still be used. It is good practice to post all relevant certificates and accreditations in a place visible to patients.
- The Internet is full of opinions about doctors of various speci alties who perform ultrasound. Some of them are negative, while others present a specialist in superlatives. Is it worth following such opinions?
W.J .: I would warn you against it, because some of them do not correspond to the truth about the doctor or the office. There are very subjective opinions, such as "because the doctor smiled at me only once." Some opinions are very unfair, because you can write anything on the Internet with impunity. I have been performing ultrasound examinations in both he alth care sectors for over thirty years and I know that the best information about a doctor's skills is family and friends who have previously used ultrasound in a given office. There are ten specialists in Warsaw that I could recommend with a clear conscience. On various forums we can find descriptions of doctors, offices and tests. I advise you to read and analyze them carefully. The longer the information, the less reliable. This is my opinion.
- How to find thesepeople?
W.J .: A few years ago, we considered organizing counseling in this area at the Polish Ultrasound Society, but the lawyers decided that it was a bad idea. The patient has to ask himself.
- Is the high price we pay for the test a guarantee of good quality?
W.J .: No. Expensive research doesn't have to be the best. The price of the test is influenced by many factors, sometimes it is even determined by the fashion for one name or another. Medical services are subject to the same laws as all others, but I consider the valuation of a fine needle biopsy at PLN 450 to be a great exaggeration. An ultrasound-guided biopsy should not cost more than PLN 250.
- What else should patients remember?
W.J .: The selection of a specialist to whom we are to be entrusted with the assessment of our he alth condition should be adjusted to our ailments or to the previously established diagnosis or treatment. In short, if we have a bad knee, let's find an orthopedist who specializes in ultrasound. If we have a problem with the eye - let's look for an oppressive one. Personally, I can recognize a foreign body in the eyeball, but I don't know what to do next. I can perform a vaginal ultrasound, but I will not interpret the results. This is the responsibility of gynecologists and obstetricians. It is important to keep this in mind in order to avoid a misdiagnosis. More than once, our facility is visited by women who have 5, sometimes 6 different breast ultrasound examinations, most of which have no diagnostic value.
- Lost money?
W.J .: Not only. Stress, anxiety about your own he alth, and in cases where neoplastic changes have not been diagnosed - significant delay in treatment, which may decide about the future.
- Is it better to use private or public facilities?
W.J .: I cannot answer unambiguously. I have my own private collection of bizarre results both from private and public ultrasound laboratories. Therefore, it is necessary to ask, ask and ask again who is doing the test. There's no other way. Despite more than 20 years of efforts by the Society and the Medical Chamber, we have not yet received a document with the rank of a regulation of the minister of he alth, which would define the conditions of who, on what equipment and where can perform ultrasound examinations.
ImportantThe greatest guarantee of professionalism in performing ultrasound examinations is the certificate of the Polish Ultrasound Society. It is a document issued under quite strict conditions and for only five years. To obtain a certificate, a doctor must have been involved in ultrasound for at least two years, he must demonstrate self-performance800 examinations, attend at least two courses in the field of various applications of ultrasound, pass theoretical and practical exams. In addition, the granted certificate must be renewed on an annual basis, which is connected with participation in subsequent trainings. A person who wants to keep the certificate must undergo systematic training.