Sonographers: The Good, the Bad, and the Ugly Attitude

I frequently have the opportunity to explain to folks outside of the medical-imaging world that there are substantial differences in the roles played by the various technologists with whom we rads rub elbows. (Usually including emphasis on the actual word, technologist, since there remains no shortage of folks who think the term “tech” stands for something else in our line of work.)

One of my major points is how tech-dependent the quality of an imaging study can be. My reading-audience hardly needs it explained that it’s not just a matter of mindlessly pushing buttons. Depending on the tech in question, an exam can range from practically being a work of art to (borrowing a term from one of my crustier mentors) dogmeat.

Flashlights in a dark room

I am particularly emphatic on this operator-dependence in my description of ultrasound. The metaphor I’ve used is that of walking into a dark room with the tech to find an errant set of keys. Just like a diagnostic abnormality in a patient, the keys may or may not be in that dark room-the only way you’ll know is if you have a thorough look.

Continuing the metaphor: You go into the dark room, and of course can’t see a thing. A tech from, let’s say x-ray, then turns on the lights, and allows your radiologist eyes/brain to have at it. At this point, unless the tech does something unhelpful like flipping the light-switch on and off or fiddling with a dimmer on it, everything in the room is illuminated. Whether you successfully find the keys, or search enough to confidently conclude that the keys are not in there, is “on you,” as the saying goes.

Related article: Those Angry Radiologists

With ultrasound, it’s different. The sonographer doesn’t flip a light-switch on the wall. Instead, s/he has a flashlight, and you’re only going to see wherever that beam of light is directed. Further, the way a lot of practices operate, you aren’t even going into the room, instead just relying on the sonographer’s word. If that flashlight doesn’t systematically paint every inch of that room, things are going unseen. And if you aren’t personally observing the whole process (or taking hold of the flashlight yourself), you don’t know for sure whether the whole room was actually searched.

There are, to be sure, a lot of good sonographers out there. They can be trusted to systematically cover every inch of that dark room with their flashlight, and if the keys are there, they’ll find ‘em. Or, if they say they didn’t see any, you can be pretty sure the keys aren’t in there.

Some aren’t as good. Maybe because they’re not as experienced yet, or don’t have inherent talent. Maybe they’re being hamstrung with crummy equipment, overbooked schedules, or types of exam that they really weren’t trained for. All of which can be compensated: The sonographer speaks up when they’re not so confident about something, letting the rad know that maybe it’s time to be a little more hands-on. Or to enlist the aid of one of the other sono-techs. Maybe the sonographer recognizes they could be better at a particular type of exam, and works to improve at it.

The telltale signs

What’s infinitely worse is when a sonographer (or, indeed, any number of other folks who are trusted to do skilled work) just doesn’t care. They’ll wave their flashlight/transducer around aimlessly for a few minutes, declare that they didn’t see anything, and move on with their day. Or maybe they aren’t that far gone yet-perhaps just 50% burned out, and still making something of an effort here and there.

In my more cynical moments, the metaphor alters: The rad walks into the dark room with the ugly-attitude tech, the tech uses the flashlight to smack the rad unconscious, maybe loots his wallet, and leaves.

Related article: I Just Work Here

Some signs I’ve seen that a given tech maybe doesn’t have the best attitude about doing a good, complete job with the faith that’s been placed in them:

• “Worksheets” provided by the sonographer are minimalist affairs, saying little to nothing (or the sonographer doesn’t bother to write one). Frequently have unhelpful fluff written verbatim-for instance, one of the techs I will soon no longer be working with writes “Cannot r/o appendicitis” on every single RLQ sono. A nice little tidbit for the medicolegal record, there.
• Routine anatomic (or pathologic) measurements that anyone else would dutifully annotate are regularly missing from the sonographer’s studies. Or the measurements are slapdash: This gets a 3-dimensional treatment, that gets 2, the other thing gets only 1. Or the calipers are placed with all the care of a Jackson Pollock painting, none actually on the margins of the structure in question. Sometimes even beyond the edges of the image.
• Calling up the sonographer to ask about one or more bits of missing information, images seemingly missing from the record, etc. not uncommonly reveals that the tech has left the facility-whether for a break, or the rest of the day. What, you want the tech to come back in? Good luck with that.
• Other sono techs, having to repeatedly cover for their ugly-attitude teammate’s behavior, show signs of getting fed up (Or leave for other jobs).