It’s a development in medical technology that would be easy to consider unremarkable: an ultrasound made portable. But in the realm of palliative medicine, where physicians work to enhance the quality of life for patients through ensuring their comfort, dignity and privacy, the Point-of-Care Ultrasound (PoCUS) has been transformative.
The PoCUS is similar to the ultrasound provided by diagnostic imaging facilities. However, it is designed to answer only one clinical question at a time at bedside and can be small enough to fit in a physician’s shoulder bag. It can be connected to a smartphone or tablet to deliver images that are read by a doctor immediately, and in the patient’s home. Clinicians can then communicate findings directly to specialists if those specialists are needed, which expedites wait-times for the patient if further treatment is required. To ensure the use of the technology is standardized, the Canadian Point of Care Ultrasound Society awards independent practitioner status to physicians who go through rigorous training and exams.
Made possible thanks to the generosity of Alberta Cancer Foundation donors in 2019, the PoCUS has proven to be a game-changer for doctors, patients and caregivers. Dr. Mehrnoush Mirhosseini, Palliative Care Physician Consultant for Alberta Health Services Edmonton Zone Palliative Care Program, says PoCUS could become as ubiquitous as the stethoscope in the future.
“The vision is that someday, each physician would have [one] in their pocket that they can use as part of their physical examination,” Mirhosseini says.
Since 2004, Mirhosseini has travelled across Edmonton as a palliative physician to meet her patients at hospices, community hospitals, long-term care facilities and their homes. She says that to treat palliative patients comprehensively, doctors must address their physical, psychological, social and spiritual needs; assessing them, she explains, in their “wholeness.”
“Palliative care is all about quality of life, dialogue and listening well,” Mirhosseini says. “We need to make sure that [patients] know what is happening, exactly what can be done, and the pros and cons of what is being offered.”
The PoCUS helps inform the dialogue between patient and physician by offering an immediate answer to a binary medical question, which can help manage symptoms and mitigate suffering.
“The findings trigger discussion at the bedside, and we can answer the questions that patients might have, which will help them to decide the future direction of their care,” she says.
That the PoCUS can provide those quick results in a patient’s home is also tremendously valuable, Mirhosseini says. When a patient is experiencing symptoms that cause discomfort, the ability to determine if a hospital visit is necessary conserves precious time and energy.
“You want to provide the right diagnosis to inform the right treatment, and you need the technology, but the patient has no energy to leave their home,” Mirhosseini says. “So, imagine that you can bring this technology to their bedside.”
The PoCUS is useful for caregivers, too. “For both of them to collect all their energy to go to [the hospital] is quite exhausting. So, for caregivers, it’s also very convenient,” Mirhosseini says.
The utilities of the PoCUS ultimately align so closely with the objectives of palliative medicine, that it is an example of a technology that proves greater than the sum of its parts — enabling care that is informed, efficient, convenient and empathetic.
“Our intention is to provide the best care possible, in a timely fashion, in the right space, and according to our patient’s wishes. This technology provides us the opportunity,” she says.