Ultrasound Pictures

[Doctor Bob]

It's been my practice recently to not give copies of ultrasound pictures to newly pregnant patients. I had too many women coming in complaining of abdominal pain which mysteriously vanished as soon as they saw their IUP on the bedside machine, then asked for copies of the pictures and refused any further workup. So now I show patients the images on the screen, but no longer make copies for them to take home.

Do you all give out pictures? If not how do you tell patients they won't get a picture without having them get upset at you?

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[EM2BE]

It's been my practice recently to not give copies of ultrasound pictures to newly pregnant patients. I had too many women coming in complaining of abdominal pain which mysteriously vanished as soon as they saw their IUP on the bedside machine, then asked for copies of the pictures and refused any further workup. So now I show patients the images on the screen, but no longer make copies for them to take home.

Do you all give out pictures? If not how do you tell patients they won't get a picture without having them get upset at you?

I tell them I don't know how to print. I honestly don't. And I tell them they need to get a professional ultrasound done at some point and they can get the picture then.

 

[Hamhock]

It's been my practice recently to not give copies of ultrasound pictures to newly pregnant patients. I had too many women coming in complaining of abdominal pain which mysteriously vanished as soon as they saw their IUP on the bedside machine, then asked for copies of the pictures and refused any further workup. So now I show patients the images on the screen, but no longer make copies for them to take home.

Do you all give out pictures? If not how do you tell patients they won't get a picture without having them get upset at you?

That used to be a very common problem for us in residency.

However, I have not encountered that for a few years!

I don't know if that is due to different demographics or because patients have learned that all ED ultrasound images are electronically transferred to PACS -- haven't been "printable" for years.

HH

 

[NinerNiner999]

"Technically" they need to sign a HIPAA release to take any part of the medical record with them, and "technically" that part of the medical record can only come from medical records....

 

[glorfindel]

"Technically" they need to sign a HIPAA release to take any part of the medical record with them, and "technically" that part of the medical record can only come from medical records....

Really? The patient needs to sign a HIPAA release for a copy of their own medical record?

 

[turkeyjerky]

Really? The patient needs to sign a HIPAA release for a copy of their own medical record?

I hav no Idea about that, but on starting residency we were told that it was a Hippa violation to look up your own chart in the emr.

 

[Colbert]

I just don't know how to print, or if its even possible at our shop. I show them on the screen and mention how inferior my bedside machine is to the much larger OB ones and refer them to our clinic if they don't have an OB.

 

[TheBlueBlazer]

If they protest, I tell them that I'll sell them a copy for $50 cash. It's the ol' Republican way - say something so ridiculous that if someone then turns around and complains to someone else about it, nobody will believe you were actually dumb enough to say something like that.

 

[glorfindel]

"The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule."

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html

So patients can inspect their own medical records and get copies of them.

I think providers are allowed to charge them a reasonable fee to make copies.

 

[NinerNiner999]

Yes they can, and technically it is a HIPAA "violation" to give them out without their signed consent. Also, they have the right to review and request that records are amended to reflect "inaccuracies". Sad but true...

 

[VienneseWaltz]

Also, they have the right to review and request that records are amended to reflect "inaccuracies". Sad but true...

But it's also disturbing how many true inaccuracies persist in charting, especially with the cut-and-paste option. When I was a medical student, I couldn't convince my resident that our patient had never had the CABG that was listed in his previous five discharge summaries until I finally got her to look at his pristine, sternotomy-scar-free chest. And don't even get me started on the error-ridden discharge summary courtesy of pediatrics after my son's delivery, which included multiple errors about my medical history, delivery events, and his exam.

 

[NinerNiner999]

You're right - but most people don't even know what CABG stands for - as scary as it is. In the ED world, I have had a few people ask me to remove "smoking" from their history in the chart because they were trying to get insurance....

 

[Flopotomist]

You guys all have ultrasound machines that print? None of ours have printers attached. I wouldn't know how to print if I wanted to!

 

[Apollyon]

It's been my practice recently to not give copies of ultrasound pictures to newly pregnant patients. I had too many women coming in complaining of abdominal pain which mysteriously vanished as soon as they saw their IUP on the bedside machine, then asked for copies of the pictures and refused any further workup. So now I show patients the images on the screen, but no longer make copies for them to take home.

Do you all give out pictures? If not how do you tell patients they won't get a picture without having them get upset at you?

I thought it was an ACEP policy position to not give out pictures due to the legal risk, as people would be falsely assured that it was a normal pregnancy, by equating your U/S with an anatomy scan at 19 weeks. Maybe I am mistaken, but that is why I don't give out pictures (and, now, I don't even know how to do it with the machine I get to use here).

 

[docB]

"Technically" they need to sign a HIPAA release to take any part of the medical record with them, and "technically" that part of the medical record can only come from medical records....

Really? The patient needs to sign a HIPAA release for a copy of their own medical record?

I hav no Idea about that, but on starting residency we were told that it was a Hippa violation to look up your own chart in the emr.

"The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule."

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html

So patients can inspect their own medical records and get copies of them.

I think providers are allowed to charge them a reasonable fee to make copies.

Remember that what the government says in the form of HIPAA and what your hospital's policy is are usually different with the hospital being much more restrictive.

My US can't print so I suggest getting rid of the printer.

 

[DoctorTinyCat]

How do you guys feel about letting a patient use their cell phone to snag a shot of the image? I'm not sure if this is really acceptable, but as a medical student, I have seen both attendings and residents allow it.

 

[Birdstrike]

This is just another example of patients, lawyers, policies, ethics and administrators pulling us in 15 different directions:


HIPAA says, "Give them a picture. It's their right!"

Hospital policy/admin/CEO says, "No picture! It's not their 'right' until the proper signatures, legal releases and disclaimers have been signed, and balance paid in full!"

Patient Satisfaction, survey SAYS! "Awwwwwuh.....give them a pictuuuuure. It'll make thesooooo happy to get that pic for free and be able to skip that 20 week visit and co-pay at the OBgyn. Puhleeeeeease. Pretty, pretty, please? 5 out of 5, for you.....yeah?"

You say, "I've got a septic kid next door, a 39 year old cardiac arrest coming in, and I don't have time for this**** ! And even if I did, ya know what? I think I just forgot how to print!"

 

[Apollyon]

How do you guys feel about letting a patient use their cell phone to snag a shot of the image? I'm not sure if this is really acceptable, but as a medical student, I have seen both attendings and residents allow it.

No dice, for the same reasons. That is foolishness.

 

[bad virus]

This is just another example of patients, lawyers, policies, ethics and administrators pulling us in 15 different directions:


HIPAA says, "Give them a picture. It's their right!"

Hospital policy/admin/CEO says, "No picture! It's not their 'right' until the proper signatures, legal releases and disclaimers have been signed, and balance paid in full!"

Patient Satisfaction, survey SAYS! "Awwwwwuh.....give them a pictuuuuure. It'll make thesooooo happy to get that pic for free and be able to skip that 20 week visit and co-pay at the OBgyn. Puhleeeeeease. Pretty, pretty, please? 5 out of 5, for you.....yeah?"

You say, "I've got a septic kid next door, a 39 year old cardiac arrest coming in, and I don't have time for this**** ! And even if I did, ya know what? I think I just forgot how to print!"

Dang government intruding on our lives. If it was up to me birdstrike, government would be just one guy in a room in Montana who gets to decide who to nuke.

JK

 

[RustedFox]

No pictures of anything. No how, no way, no matter, no nothing.

Any bit of amateur photoshopping can be a potential disaster.

See: Brazzers Meme.

 

[VienneseWaltz]

You're right - but most people don't even know what CABG stands for - as scary as it is. In the ED world, I have had a few people ask me to remove "smoking" from their history in the chart because they were trying to get insurance....

🙄 Lovely...

But the residents who write the dc summaries should know what CABG means!

And on the other end, it would have been totally awesome if anyone from 2008 onward had bothered to mention my septic patient's VA shunt--or any history of intracranial pathology--before we spent 15 minutes trying to place an IJ on that side ("Dr. Waltz, the wire just won't thread!" Meanwhile I'm looking at the post-ETT CXR which notes her CVC is "unchanged from prior"...)

As for the topic at hand, I don't think our ultrasounds print, either, and we tell our patients that our machines are like Honda civics, whereas the ones OB has are cadillacs.