The ethics of incidental findings

The ethics of incidental findings: James Rippey Ultrasound is an incredibly useful tool for clinicians. According to James Rippey, there are two main groups of clinicians who use ultrasound. First, there are the POCUS providers, who have a specific, focused question and use the ultrasound machines accordingly. Then, there are the ultrasound experts, who look beyond the specific questions and embrace ultrasound as a valuable diagnostic tool. The advancement of high quality, handheld ultrasound machines means that we will all have imaging available at our fingertips. Notably however, questions are raised regarding the impact that these machines can have on families and the ethics behind incidental findings. James shares a personal story about how using a handheld ultrasound machine on his son, incidentally found a retroperitoneal tumor. Luckily James’s son survived, however it raises questions as to the risk-benefit ratio in the discovery of an incidental finding. This extends not only to the likelihood of the finding being serious but also to consider the financial and emotional costs of incidental findings. It causes us to consider Ethics in Healthcare and the value of procedures that can be unnecessary. For those practicing POCUS (the simple single question, focused form of bedside ultrasound) James’s suggestion is to remain focused and not be distracted by incidental findings that you are not qualified or taught to recognise. Communication regarding the limitations of your scan is far more important. For those clinicians with advanced ultrasound education, James encourages you to identify and consider any incidental findings you come across while performing an ultrasound. Rely on the help of other experts to guide interpretation of incidental findings where appropriate. Tune in to a DAS SMACC talk by James Rippey on the Ethics of Incidental Findings.

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