This month we will consider the potential ethical pitfalls of costly new technology—and we want your help. Tell us how you would address this ethical dilemma by e-mailing dantoline@wiley.com.
The Situation
My partners would like to buy an ultrasound machine to generate more income. I feel very conflicted because I am concerned that once we have the machine, we might be tempted to use the ultrasound more than necessary. My partners counter we are not being paid adequately for our cognitive services and this is the only way we will be able to survive professionally. However, I have several dilemmas. First, there is currently no standard of care or guidelines to establish when musculoskeletal ultrasound is appropriate for diagnosis, monitoring care, and/or intraarticular injections. Second, I am concerned that I will be tempted to aggressively treat small erosions or mild synovitis that is of questionable clinical significance. How should we decide when it is appropriate to use ultrasound? Is it ethical to buy a piece of technology as a means of generating revenue? And, finally, I understand that the learning curve is pretty steep. How will I know that I or my partners are adequately trained in ultrasound use?