Maxime Valois is an attending physician in the emergency department of Charles-LeMoyne Hospital and the intensive care unit of Verdun Hospital in Montréal, Québec, Canada. His appointments include roles as associate professor at Montréal, Sherbrooke and McGill Universities. He is one of the founders of the Echo-Guided Life Support course, and a professor of the Ultrasound Leadership Academy. His medical interests include critical care, development of electronic templates (co-developer of the « shock echo » iOS application) and medical education. He also enjoys reading philosophy, hicking and wine tasting (the latter probably comes with his French accent). He has a wife and two young daughters.
POCUS is a Problem - PRO
POCUS while having undeniable advantages is also generating headaches that we should address before POCUS itself becomes the main problem
Point-of-care ultrasound (POCUS) is gaining widespread acceptance in the various medical sub-specialties and is progressively being integrated in pre-graduate medical curriculums around the world. It has helped physicians throughout the world to make easier, more accurate and faster diagnoses. It has contributed to enhance the diagnostic possibilities in resource-scarce environments.
As it is gaining widespread acceptance, the use of POCUS is currently shifting from the hands of motivated technology-eager early adopters to those of just about every physician, trainee and student entering the house of medicine. This scientific revolution will inevitably change the way medicine is practiced in the years to come. Of all times, many problems and difficulties have been created by such shifts in scientific dogmas.
Research and use of fancier, new or more advanced applications are likely to help the global advancement of POCUS and even medicine in general. But as POCUS, enters fully in its stage of normal science, this will inevitably induce some degree of scientific esotericism. This has been the case of all past scientific revolutions. However, in a world in full acceleration where knowledge translation times are dropping, the side effects of normal scientific activity can be expected to be somewhat magnified in comparison with previous medical and scientific revolutions.
The importance of defining and understanding test characteristics, like specificity and sensitivity, is a major challenge that many physicians using POCUS are already facing. And the widespread integration of POCUS in medicine will need to take into account the pressures of decision-making in a naturalistic setting (in the clinical setting) and the human factors governing the use of this technology. This is critical if we want POCUS to grow better in the midst of its own revolution.
Point-of-care ultrasound is already generating some important difficulties. If these go unattended, I believe POCUS itself might rapidly be a problem.