General Practitioners’ Experience with Ultrasound in Primary Care: Insights from the French-Speaking Ultrasound Congress

2024-02-21 04:00:00

On the occasion of the 2nd edition of the French-speaking ultrasound congress, which was held on February 1, many general practitioners spoke about their practice of ultrasound within their practice. Although this practice is not yet recommended by the High Authority for Health, general practitioners believe that this tool allows them to “save time” in the care of their patients. So much so that some indicate that it could facilitate access to care, particularly in medical deserts.

If some municipalities seem more spared, in others, you sometimes have to wait up to a month to get an appointment with a radiologist. In emergency departments, waiting times are also getting longer. What if the ultrasound machine used by general practitioners was one of the solutions? On the occasion of the 2nd edition of the French-speaking ultrasound congress (or targeted clinical ultrasound, ECC), which took place on February 1 in Paris, several general practitioners recounted their experience since they carried out breast ultrasounds. of their office.

It was in 2009 that Dr Dominique Rémy, a general practitioner in Vendée, decided to invest in an ultrasound machine, to “do a service”. Today, the doctor recognizes that this has “exchange [sa] vie”. Because for him, this tool “above all allows us to improve care”. He remembers a 19-year-old patient who came to consult him six months after falling on her left buttock. Since her fall, the young woman has had a bump that she wants to remove. The doctor considers that there is no emergency, but “given the difficulties of accessing imagery” in his department, he decides to do an ultrasound in his office and notices in the image the presence of a “boule”. “I take a Doppler scan and then I tell myself that it’s not a lipoma”, he remembers. The Vendée general practitioner referred him to a colleague and prescribed an MRI. It reveals a “parenchymal formation of fatty tissues with enhancement within”. A biopsy is performed and reveals alveolar sarcomas of the soft tissues. The patient is treated immediately. “If there was no early ultrasound done by a neophyte, it could not have been detected early”, explains the doctor.

Is the radiologist the future of the general practitioner?

Dr David Macheda, a general practitioner in Haute-Savoie, remembers the request for a regulatory doctor in his region. The latter had just received a call from a 73-year-old patient, who complained of calf pain, with the presence of a sting. He suspects erysipelas and should refer the patient to the emergency room, but the waiting time is 5.5 hours. So he asks Dr. Macheda if he still has his imaging device. The general practitioner then decides to take care of the patient in his office. He performs a targeted ultrasound at the site of the bite and finally diagnoses phlebitis. The doctor then prescribes the appropriate treatment. “With the ultrasound machine the diagnosis is immediate and the patient is back home less than an hour and a half after his call to 15”, he believes. While he recognizes that in certain situations this can help relieve emergency room congestion, he adds that it also costs “much cheaper for the community”.

“In ten seconds the diagnosis is made”

The ultrasound machine used by general practitioners also makes it possible, according to Dr. Patricia Lefébure, general practitioner in Yvelines and president of the Federation of Physicians of France (FMF), to not miss certain diagnoses. She recounts the case of a patient in whom she discovered a pleural effusion in the left lung thanks to her device. “In ten seconds, I placed the probe at the site of his pain, and that’s it, the diagnosis was made”, she notes. However, this patient had already had a CT scan, the report of which indicated: “there is a slight felting in the right diaphragmatic osso sac.” “The radiologist had seen something but he still concluded ‘normal scan’ in the end”adds Dr. Lefébure.

A new probe “that fits in your pocket” to “make medical imaging accessible to all caregivers”

If she had not had an ultrasound machine in her office, the GP would have sent her patient for imaging, “probably a expensive grill, but that obviously wouldn’t have done anything”, she specifies. In addition, with the “chain” of personnel between the patient and the radiologist, she recognizes that the doctors could have missed the correct diagnosis. “When the patient arrives at the emergency room, the intern scribbles “chest pain, suspicion of pulmonary embolism”. Then, it’s the technician who does the scan and sends it to the radiologist. Ultimately the radiologist has no connection with the patient”she notes in the majority of cases. “If the radiologist had seen the patient and knew that he had pain precisely in that area, perhaps he would not have concluded ‘normal chest CT’”she asks herself.

If he decided to equip himself it is “to be able to do a little more things” in his practice, comments Dr Richard Talbot, general practitioner in Manche and member of the FMF. The practitioner practices in a rural sector, with few specialists. But he wants to make it clear that he…

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