A university reunion I attended in Germany was the catalyst for adding ultrasound diagnostics to our practice’s services.
At the reunion I discovered that a lot of my family doctor friends used ultrasound in their practices. This inspired me to introduce ultrasound to our practice, which we funded ourselves, as an additional tool for diagnosing patients.
I went medical school in Germany and came to England for most of my postgraduate training and qualified as a GP in 1999. Since then, I have been a GP partner in inner London at our two-site training practice where there are 11,000 patients.
Training and equipment
I perform all the ultrasounds and my training for this was spread over one year with a weekly practical session and several intense blocks of theory. I was awarded the Postgraduate Certificate Focused Ultrasound four years ago.
I have since performed more than 800 scans at our practice using a small portable unit that cost around £15,000. A lot of the time the scans are performed opportunisticallly and have become part of the patient examinations, just like using a stethoscope.
I also have dedicated ultrasound time slots built in so that the other GPs can refer patients to me for an ultrasound-supported opinion covering general abdominal scans, kidney/bladder and prostate with residual volumes, superficial and vascular structures such as aortic aneurism screening.
As I am also a GPSI for treating substance abusers, I use the scan for hepatic assessments and to gain venous access in ‘difficult-to-bleed’ patients.
While so far the practice has had to fund the service, it is a great convenience for patients and rewarding for me as a clinician. In my experience, the biggest incentive for other practices to take it on is that patients express a great deal of satisfaction at having their scan in the familiar setting of their GP practice rather than in a more threatening hospital environment.
Before each ultrasound I discuss with the patient what the scan could reveal and after it, discuss the possible treatment options with them.
Ultrasound has become a very useful addition to patient examinations and provides a great deal of clinical confidence when it is used as a ‘rule in test’ (as opposed to ruling out a condition).
Scanning at the practice obviously cannot replace the more sophisticated hospital systems and patients who need to be sent for a more detailed work up will continue to be evaluated in the local radiology department.
I believe that the key factors for successfully using ultrasound in primary care are that the GP needs to acknowledge their limitations and to keep up to date through appropriate training courses.
In my experience, patients express high levels of satisfaction with being scanned in the familiar setting of their GP practice as this is less threatening than the hospital environment.
They receive an explanation of possible findings and can have a discussion about possible treatment options in the same setting by their own doctor.
Ultrasound in general practice is a useful, additional diagnostic tool and GPs do not have to be cardiologists or chest physicians to use it.
Advantages of on-site ultrasound
Dr Axel Schuttpelz is a GP at the Ampthill Practice in central London