Learning Philosophy

Say no to Gizmo Idolatry

I freely admit to being an early adopter of handheld ultrasound. But I want you to know that I am am not a Gizmo idolater.

I strongly believe in the classics of medicine. History, examination and basic tests -in medicine these are a CXR, ECG etc. I am also a believer in eliciting signs. (Does the valsalva increase the ejection systolic murmur, it there pulses paradoxis). Technology only provides clinical answers to clinical questions. Sometimes no imaging is best as it will not differentiate the diagnosis or management. If hand held ultrasound does offer an avantage to the clinician it is in the proximity of the testing and interpretation. However everything has trade offs on a busy admission or ward round.

Leff B, Finucane TE. Gizmo idolatry. JAMA. 2008 Apr 16;299(15):1830-2

Bayesian and fagan's nomogram

Ultrasound is just an extension of the clinical exam. Before firing up the probe clinical questions with probabilities should be in mind. You may have rule in/ rule out questions and a risk assessment of your findings to guide further investigations, management or disposition of the patient. 

So you think you're a hot shot

Taking POCUS as an example, adoption of this skill individually or roled out in a profession will follow this pattern. The purpose of a physician intergrating ultrasound into their practice is to move to the right through the highs and lows and learning from overconfidence to wise deployment

Index of Australiasian POCUS sites

IMSANZ Point of Care Ultrasound (POCUS) Special Interest Group:  when only the best will do. Still in its infancy

Echocardiography Society of Australia and New Zealand. More heart focused but good resource

Pocus Revolution : An emergency trainee active between 2019-2021

EMUGS: Emergency orientated POCUS group

 

Links to POCUS articles of note

Point-of-care ultrasound: ready for prime time in internal medicine? Internal Med Journal 2023 

Stories told in pixels

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