Original Article

Point-of-Care Ultrasound Improves Shared Diagnostic Understanding Between Patients and Providers

Authors: Benji K. Mathews, MD, Paula E. Miller, MPH, Andrew P.J. Olson, MD


Objectives: Point-of-care ultrasound (POCUS) has become an integral part of the physical examination. The effect on shared understanding of adding POCUS to the traditional examination is unknown, yet this is an often-described benefit of POCUS. The primary aim of this study was to determine whether the use of POCUS improves shared understanding between providers and patients about patients’ diagnoses.

Methods: This was a prospective controlled trial involving a convenience sample of hospitalized adults. Providers in the control arm performed usual care without POCUS, whereas providers in the study arm had the option to add POCUS. Surveys were administered to the subjects and their providers with questions on patient understanding of symptoms, diagnosis, and main contributors to their health problem. Two independent physicians rated the degree of shared understanding between patient and provider surveys.

Results: Of the 64 patients enrolled in the study, 60 had complete data. There was increased shared understanding between providers and patients with respect to their diagnosis (POCUS 9.56 ± 0.63, non-POCUS 7.62 ± 1.63, P < 0.005) and main contributors (POCUS 9.65 ± 0.77, non-POCUS 8.30 ± 1.13, P < 0.005) in the POCUS arm compared with the non-POCUS arm. Patients also increased the self-rating of their understanding of their health problem in the POCUS arm.

Conclusions: These findings suggest that using POCUS improves patients’ understanding of the diagnostic process. POCUS may be uniquely poised to enhance patients’ understanding of and engagement in that process.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Elwyn G, Laitner S, Coulter A, et al. Implementing shared decision making in the NHS. BMJ 2010;341:c5146.
2. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012;27:1361-1367.
3. Berger Z. Navigating the unknown: shared decision-making in the face of uncertainty. J Gen Intern Med 2015;30:675-678.
4. Godolphin W. Shared decision-making. Healthc Q 2009;12. Spec No Patient:e186-e190.
5. Windover A, Boissy A, Rice T, et al. The REDE model of healthcare communication: optimizing relationship as a therapeutic agent. J Patient Exp 2014;1:8-13.
6. Sehgal NL, Green A, Vidyarthi AR, et al. Patient whiteboards as a communication tool in the hospital setting: a survey of practices and recommendations. J Hosp Med 2010;5:234-239.
7. Spevack R, Al Shukairi M, Jayaraman D, et al. Serial lung and IVC ultrasound in the assessment of congestive heart failure. Crit Ultrasound J 2017;9:7.
8. Soni NJ, Franco R, Velez MI, et al. Ultrasound in the diagnosis and management of pleural effusions. J Hosp Med 2015;10:811-816.
9. Boyd JH, Sirounis D, Maizel J, et al. Echocardiography as a guide for fluid management. Crit Care 2016;20:274.
10. Mantuani D, Frazee BW, Fahimi J, et al. Point-of-care multi-organ ultrasound improves diagnostic accuracy in adults presenting to the emergency department with acute dyspnea. West J Emerg Med 2016;17:46-53.
11. Glockner E, Christ M, Geier F, et al. Accuracy of point-of-care B-line lung ultrasound in comparison to NT-ProBNP for screening acute heart failure. Ultrasound Int Open 2016;2:E90-E92.
12. Bhagra A, Tierney DM, Sekiguchi H, et al. Point-of-care ultrasonography for primary care physicians and general internists. Mayo Clin Proc 2016;91:1811-1827.
13. Crisp JG, Lovato LM, Jang TB. Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department. Ann Emerg Med 2010;56:601-610.
14. Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005;12:601-606.
15. Narasimhan M, Koenig SJ, Mayo PH. A whole-body approach to point of care ultrasound. Chest 2016;150:772-776.
16. Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 2008;6:16.
17. Soni N, Arntfield R, Kory P. Point-of-Care Ultrasound. Philadelphia: Elsevier; 2015.
18. Moore CL, Copel JA. Point-of-Care ultrasonography. N Engl J Med 2011;364:749-757.
19. Schnobrich DJ, Gladding S, Olson AP, et al. Point-of-care ultrasound in internal medicine: a national survey of educational leadership. J Grad Med Educ 2013;5:498-502.
20. Society of Hospital Medicine. Point-of-care ultrasound certificate of completion for hospitalist. https://www.hospitalmedicine.org/clinical-topics/ultrasonography-cert. Accessed January 24, 2018.
21. Mathews BK, Reierson K, Vuong K, et al. The design and evaluation of the Comprehensive Hospitalist Assessment and Mentorship with Portfolios (CHAMP) ultrasound program. J Hosp Med 2018.
22. Ultrasound Institute, University of South Carolina School of Medicine. Four-year ultrasound curriculum. https://www.sc.edu/study/colleges_schools/medicine/education/md_program/curriculum/integrated_ultrasound/index.php. Accessed January 24, 2018.
23. Howard ZD, Noble VE, Marill KA, et al. Bedside ultrasound maximizes patient satisfaction. J Emerg Med 2014;46:46-53.
24. Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med 2010;170:1302-1307.
25. Sackett DL. The rational clinical examination. A primer on the precision and accuracy of the clinical examination. JAMA 1992;267:2638-2644.
26. Garcia-Retamero R, Okan Y, Cokely ET. Using visual aids to improve communication of risks about health: a review. ScientificWorldJournal 2012;2012:562637.