As Prices Drop, Point-of-Care Ultrasound May Spark Evolution of Physical Exam

In a commentary for JAMA Cardiology, John Kugler writes, “The ‘wow’ factor is powerful with the latest generation of pocket ultrasound machines. The ability to connect to tablets and smartphones and to be carried in a pocket or bag makes the machines revolutionary for working on the inpatient medicine wards. There is no question that my patients and learners welcome insonation as part of the physical examination.”

Although Kugler says he’s been using the well-liked (and effective) technology for 10 years to enhance the diagnostic capabilities of the physical examination, a point-of-care ultrasound (POCUS) revolution has not arrived. Slow adoption can be attributed to the lack of an integrated ultrasound curriculum in most medical schools and limited use of ultrasound in graduate medical education (not to complement physical exams but rather to guide procedures).

Incorporating POCUS in medical schools and residency programs takes time and money, says Kugler: “time and money to train faculty, money to purchase equipment and time to educate residents.” Even when a curriculum includes POCUS training, it’s “best done at the bedside and in small groups,” which makes it difficult to incorporate and scale.

Although the price – about $9,000 depending on the device –  is currently prohibitive for individual residents to purchase, Kugler says the market is starting to introduce more affordable options. That’s what gives him hope for pocket ultrasound technology, which he believes will help the physical examination evolve. “A steep reduction in cost,” writes Kugler, “will put devices in the pockets of learners and educators in a way that the evidence of efficacy has not and will spark a growth in our physical examination that has been a long time coming.”

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