Back to the bedside: Using point-of-care ultrasound
Radiography was such a wonder at its inception that the fallout became an afterthought. Radioactive shoe-fitting machines found themselves on the aisles of department stores as amusing sales gimmicks, snatched away only years after we appreciated the harms of radiation exposure.1
Mechanical ventilation ushered in an era of critical care medicine, a specialty that now practices some of the most dramatic—and expensive—nonsurgical interventions in healthcare. But long after we could keep the human body alive without meaningful brain function, debate about the moral, ethical, and legal implications rages on.
We seem to have made a habit of thrusting an innovation into service before we fully consider its effects, even if the consequences conflict with our own collective conscience. Primum non nocere long ago became “first, press the button.”
But there may be a technology that, for once, does not put us at odds with our own principles. The emergence of widespread use of point-of-care ultrasound offers a marriage of technology and medicine that may let us keep our vows.
As illustrated in the article by Fuller and Norman in this issue (page 48), point-of-care ultrasound has a wide range of clinical applications. It is no longer a technology chaperoned by sonographers and interpreted by radiologists; it is the bedside tool of the generalist and specialist alike, the pragmatic, new-age stethoscope.
But the rise of ubiquitous ultrasound supports a trend in medicine more important than any shiny new toy. It aligns with a philosophy that focuses not on the prestige of the individual clinician but the information at his or her fingertips. It supports evidence over eminence. It puts empiric data within arm's reach. It places patient safety back on the cutting edge.
Point-of-care ultrasound can answer questions that once required a dose of radiation—and the risk and price tag that comes with it. Now we can rule out a pneumothorax in a harmless instant.2 We can differentiate cellulitis from abscess without IV contrast—and without piercing the skin.3
Point-of-care ultrasound removes our reliance on the periodic mythology and dogma of fickle physical examination findings. We can assess cardiac function at the bedside with more than a vague search for crackles and a sage stroke of our chins.4
For perhaps the first time in the history of medicine, the newest and most effective applications of technology are safer and cheaper than their predecessors. The feather-light weight of ultrasound has—ever so slightly—tipped the scales of risk and benefit in favor of the patient.
Of course, this power also comes with an added responsibility. In an era of splintered, ultraspecialized medicine, point-of-care ultrasound demands that we embrace our generalist roots and cultivate a broad skillset. To maximize the benefit of bedside ultrasound, we must invest the time and energy to become competent, self-sufficient operators—technician, clinician, and diagnostician all at once.
In a strange way, the forward march of technology has come full circle. The ultrasound machine places the focus of medicine back where it began: in the hands of a single, caring individual standing at the patient's bedside.