Ethics/Professionalism in the ultrasound department
Sonographer ethics: Case study
Ethical scenario: A sonographer makes judgmental comments to a fifteen-year-old pregnant girl getting a sonogram
Sonographer ethics: Case study
Ethical scenario: A sonographer makes judgmental comments to a fifteen-year-old pregnant girl getting a sonogram
Sonographers deal with women when they are at their most vulnerable: gynecological sonography is designed to spot potential difficulties in a women’s pregnancy that could result in complications for the woman or her developing fetus. Occasionally, in the case of serious problems, a patient may need to consider terminating her pregnancy. Even if the news the pregnant woman receives is positive, it is essential that the sonographer appears to be professional and objective in his or her demeanor. The woman must feel as if the advice she hears is based purely upon medical facts and is given with respect to her medical interest and personal beliefs and values — regardless of whether the sonographer approves of those values or her lifestyle.
In this instance, a young, fifteen-year-old girl came for a sonogram. The sonographer made disparaging comments about the girl’s youth. When the girl asked questions about the procedure, the sonographer ignored her comments and said that she should talk to her parents. After the sonogram, the medical professional, as well as informing the family of the results, upbraided them for not ‘watching’ their daughter and taking better care of her. A similar instance of teenage pregnancy had occurred in the sonographers own family, and the medical professional shared this information with the family.
“Over the last 20-25 years, it has become routine for pregnant women to have a sonogram during their second trimester — between 18 and 20 weeks. The screenings can confirm the health of the fetus. it’s becoming more common for women to have screening sonograms during their first trimester” depending upon their medical condition and/or age (Orenstein 2010). Both older and teenage girls have additional risks of manifesting a high-risk pregnancy, which is one reason why the issue raised in the case scenario is so serious. The sonographer should strive to make the young patient feel more rather than less comfortable over the course of what can be a stressful and confusing process. Additionally, the sonographer might have to perform procedures upon other young patients in the future and should know how to comport him or herself in an appropriate manner. In this instance, the sonographer should be disciplined and sent to receive additional counseling and training in patient relations. If the reason for the sonographer’s behavior was personal in nature, the individual may need to consider counseling not specifically related to his or her job. Ethics and conduct should be reviewed in retraining classes, and spelled out in the employee handbook, for all professionals within the healthcare environment.
Just like doctors, nurses, and other healthcare professionals, sonographers are bound by a code of professional ethics that must be observed at all times. There are also additional ethical complications when the individual in question is not yet of legal age, when a sonographer does not adhere to that ethical code. The sonographer must observe the required privacy protocols, as specified under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which demands that professionals “maintain confidentiality of acquired patient information, and follow national patient privacy regulations” (SDMS: Code of Ethics, 2010, SDMS). In this instance, the sonographer did not ask for the girl’s permission to share information with her parents.
It is true HIPAA gives considerable leeway to healthcare providers for underage patients: “a provider may withhold information from a parent/personal representative if ‘in the exercise of professional judgment…it is not in the best interest of the individual to treat the person as the individual’s personal representative,’ as in the case of an abusive parent (Minors, 2005, Miller School). But a provider may also “use his/her professional judgment to disclose health information to a parent, even in cases that otherwise meet an exception, as ‘necessary to avert a serious and imminent threat to the health or safety of the minor'” such as if a minor begs a doctor not to tell his or her parent that s/he is being sexually abused (Minors, 2005, Miller School). However, given the circumstances of the case, the sonographer went ‘out of bounds’ in addressing the parents without the girl’s permission about her condition, as well as introducing personal information.
HIPPA suggests a sonographer should ask if the young girl would like her parent to be there during the discussion of the procedure, and if the patient gives consent, inform the patient and her parents of any risks that might come to light. If the girl’s life is judged to be at risk because of unexpected complications, this should also be broached with her parents, although the girl’s cooperation should first be sought. Thus the degree of confidence placed in healthcare professionals to exercise sound ethical discretion when dealing with minor patients means that individuals in a position of trust have profound responsibilities. The moral judgment of the sonographer of the young girl should not be an issue in his or her treatment. In the case of a fifteen-year-old seeking a sonogram, the sonographer is bound to examine the girl to his or her fullest capacity, given that one ethical tenant of the profession is to adhere “to oversight and approval of investigational procedures, including documented informed consent” (SDMS: Code of Ethics, 2010, SDMS). Protecting a patient’s rights, including the right to privacy and to refuse a procedure, is paramount, according to the profession’s ethical code.
A final, important reminder in terms of the ethical need for trust is that the patient, if confronted by an abnormal pregnancy, may need to contemplate terminating the pregnancy. The patient must have confidence that the medical information provided by the sonographer is accurate, and not tainted with bias, based upon her age. When the patient walks into the examining room, she must feel as if the only concern is the health of her fetus and her own health, not the personal issues of the sonographer and his or her religious or psychological issues. If the patient does not have confidence in the sonography and the medical profession as a whole she may engage in poor decision-making and there may be long-standing ramifications for her future. This is why swift and effective discipline is necessary against the sonographer, including counseling on a professional as well as a personal level. Regardless of the competence of the individual at his or her task, ethical competence is also demanded in the healthcare profession.
References
Minors, privacy rights of (HIPAA). (2005, May 12). Miller School of Medicine. University of Miami. http://privacy.med.miami.edu/glossary/xd_minors.htm
Orenstein, Beth. (2001). News Wave. Society of Diagnostic Medical Sonography.
Retrieved August 8, 2010 at http://www.sdms.org/members/news/NewsWave/NW-April-2010.pdf
SDMS: Code of Ethics. (2010). SDMS. Society of Diagnostic Medical Sonography. Retrieved August 7, 2010 at http://www.sdms.org/about/codeofethics.asp
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