Revisiting My Stance On Ultrasound Machines

   I keep a one-eyed monster locked in the staff bathroom of my clinic. I am not afraid of the thing. There just is not another practical space to store it and I am kind of embarrassed about having it. It is a diagnostic musculoskeletal ultrasound machine.    Most DPMs would be proud to have this stylish symbol of high-tech medicine displayed where all could see it. I keep mine hidden because I am the guy who authored a very negative editorial about diagnostic ultrasound units in podiatry offices.    I encountered a bunch of salespeople at the APMA national meeting a few years ago. They were making pitches for various models of diagnostic ultrasound, mostly focused on the reimbursement potential for the machines. They touted them as “practice builders.” I came home from the meeting and wrote an article slamming all forms of gimmicks that DPMs use to generate revenue (see “Thinking Twice About Revenue Enhancement Opportunities,” April 2004).    Many of my colleagues were angry and sent letters or e-mails stating their collective opinions of me. There was one positive letter and about 75 telling me where I could place my next article (in a location where it could only be read with an ultrasound probe).    Now I have an ultrasound unit. It is embarrassing but there is a reason why. An angry patient showed up at my office about five months ago and demanded her medical records. She told me the “ankle sprain” I had been treating turned out to be a ruptured peroneal tendon. Another podiatrist found the problem with his diagnostic ultrasound and subsequently confirmed the diagnosis with a MRI study. The patient asked if I had ever heard of diagnostic ultrasound. I did not tell her about my editorial on the subject.    A string of other patients who went to my colleague for second opinions returned with similar comments. “Why didn’t you use ultrasound to diagnose my plantar fasciitis or Achilles tendonitis…?” The list went on and on.    Three months ago, I called one of the ultrasound companies. I still had the company’s sales brochure from when I wrote the infamous column.    "This is Dr. John McCord and I am calling about …”     “I know who you are,” growled a male voice. “I read your article. What do you want?” This was not the unctuous salesman’s voice I expected to hear.     “I would like to talk to you about ordering an ultrasound unit.” I waited for him to slam the phone down.    He turned out to be friendly and helpful. He admitted that my editorial stung but caused him to modify his approach and to be aware of doctors who may simply be looking for a practice builder. He is quick to remind doctors that they must thoroughly understand the conditions that they are trying to evaluate and to use ultrasound as an adjunct to their diagnostic skills, not as a screening/revenue raising tool.    Trauma is a large part of the practice and my partner and I were relying on expensive MRI studies too often to sort out soft tissue injuries. The salesman turned out to be an ultrasound technician and his knowledge of trauma and the use of diagnostic ultrasound helped me decide to purchase a unit. It was the largest check I have ever written for a piece of equipment. Actually, I put it on my British Airways Visa card and scored a business class upgrade for my next vacation.    The machine arrived several weeks later in five large boxes and took a few hours to assemble. I slopped ultrasound gel all over my foot and the floor of the office, and scanned my plantar fascia. The image on the screen looked as clear as my parents’ first black and white Magnavox TV after a windstorm blew the antenna off the roof.    The company rep suggested that we play with the unit for a few weeks. Then he flew out to teach the doctors and staff of the clinic how to use the machine. With his instruction, we understand how ultrasound works and what clinical information we can obtain from it. He also taught us how to generate meaningful reports of our findings.    I used it today to confirm a partial rupture of a plantar fascia. The patient had already seen two other non-podiatric physicians who had used X-ray and a CT scan. She asked why they had not thought to use ultrasound.    I patted my ultrasound machine on the top of the screen and locked it back in the bathroom. Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.