Well, Tuesday morning clinic was busy as usual. Hypertension, diabetes, depression, “it-hurts-here”s where troubling all my patients. My desk was across the hall from a colleague who had just seen a retired internist gentleman, 80 years old, reporting muscle weakness in his hips, fatigue, bitemporal headaches, and some odd jaw symptoms when he ate. Don (I called him that, mostly because that was his name.) was investing some quality phone time trying to arrange a temporal artery biopsy as this method for diagnosis seemed so reasonable to him and to his internist patient. I listened in on his conversation, always ready to help, invited or not.
“Don, you know, if we pull our portable ultrasound machine, look at his temporal arteries and he has bilateral halo signs, the specificity approaches 100% for temporal arteritis and you can avoid biopsy all together in 38% of patients.” I provided him a few convincing articles. He was not quite sure as he had never heard of this before.
Both internists were game, the doctor and the patient. Portable US in the exam room showed bilateral halos around the temporal arteries. I showed them the finding. Both raised their metaphorical eyebrows.
Patient: “I practiced internal medicine for almost 50 years and I have never seen anything like this. That is pretty impressive.”
Don: “Let’s get a sed rate today… See what that shows. Start some steroids and we’ll follow-up next Tuesday.” (For those not in-the-know, sed is erythrocyte sedimentation rate.)
On Friday, after 3 days of steroids, he was starting to feel like his old self again. Headaches were resolving. Fatigue was much better. By Tuesday, with his visit to the clinic, he was ecstatic over his progress. Don reported that he kept remarking on that young man with his portable US machine (That was me.) and how that US would’ve changed his practice had he had one back then.
On Thursday, the patient wanted to show his appreciation to both Don and I by bringing in 2 bottles of red wine, 1 for him and 1 for me.
I had read about the utility of portable ultrasonography, oh, 12-15 years ago for the first time. I had drunk the cool-aid of portable ultrasonography. At our medical school, we provide 27 hours of didactics and hands-on training for our medical students in their first 2 years. Our internal medicine residents get formal didactics on echo, abdomen, vascular, as well as MSK, small parts, and many other US applications. We have provided CME for over 700 physicians in our 3- and 4-day courses. I have been convinced that we need to reach out and teach all who will listen that portable ultrasonography can fundamentally change the way we practice medicine in certain settings.
So portable ultrasound changed this patient’s experience; quicker diagnosis and quicker recovery of health. He was grateful and expressed his gratitude with the fruit of the vine.
So portable ultrasound changed my colleague’s thoughts on its utility based on one clinical exposure. Don asked me many times to use my machine for other patients of his.
So what did I get from this profound, thought-provoking intersection of patient, doctor, and too? Personal gratification of helping? An underscoring of my belief that portable ultrasonography is important?
I got a nice bottle of wine!
Do you know of an instance in internal medicine in which ultrasound resulted in a quicker diagnosis? Have you incorporated ultrasound into your internal medicine practice? Comment below or let us know on Twitter: @AIUM_Ultrasound.
Apostolos P. Dallas, MD, FACP, CHCP, is Assistant Professor of Medicine at Virginia Tech Carilion School of Medicine, Director of CME at Carilion Clinic, and Associate Program Director of the Internal Medicine Residency program at the Virginia Tech Carilion School of Medicine.