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How an Independent Sonographer was created

Jeanette Burlbaw - Thursday, May 2, 2013

My office is unlike any other because I created it.  After 25 years in traditional perinatal departments I believed I could fill the personal needs of the patient, compliment their physician/midwife’s care and offer affordable diagnostic exams.  

My story:

In 2001 several patients complained that I had only spent 15 minutes with them.  They felt rushed and dismissed.  A skilled sonographer can evaluate a pregnancy in that little time, but it doesn’t allow for personal time for the patient.  The patient often doesn’t find out the sex or simply see how their baby moves.  They were mad at me, but I had patients lining up in my waiting room and a full schedule to complete.  The sonographer’s primary goal in that setting is to get the information the physician/midwife needs to evaluate the pregnancy and complete a report.

I went home to my CPA husband and started talking about how, with the new 3D equipment, I thought I could fill the diagnostic need and social needs of both patient and managing midwife/physician.  He believed in me and with his help I jumped into small business life.

I bought the best equipment available and set my schedule to allow an hour for each diagnostic and 3D patient exam.  I didn’t want to be rushed nor did I want my patients or the friends and family that accompanied them to feel rushed.  My intent was for everyone to leave with their questions answered and happy.  I searched for the best reporting package and contracted with a skilled experienced physician to interpret my diagnostic exams.  I attempted to set the price of both exams to make it a great experience and affordable.

I don’t file for insurance for several reasons.  The first company that I contacted was Blue Cross and Blue Shield and they wouldn’t give me a provider’s number because I am not a physician.  I didn’t want to complicate things by asking my interpreting physician if I could use his practices number.  The complications, time and expense of billing did not seem like I was doing what I had intended – keep life simple.  The patient can submit for reimbursement when their insurance allows.

I was a naïve sonographer.  My first surprise was how frequently malformations are overlooked at the traditional 20 week sonogram.  I still believe I see them because with my 3D exam they are much further along, I have remarkable equipment and I spend an hour showing the patient every little thing.  One percent of my patients in the first 3 years had a malformation that had not been noted during the 20 week sonogram.  When a malformation is noted I do a diagnostic exam at no additional cost to the patient and notify the managing midwife/physician concerning the finding.  They never leave without a discussion of what I saw and with an idea of when they will see their managing midwife/physician. I cannot impress upon patients, physicians and midwives alike how important each time a transducer is placed on the patient’s abdomen to be sure a credentialed sonographer holds that transducer and evaluates the anatomy. 

I encountered an unfounded fear of 3D/4d sonography.  Many physicians/midwives and patients think that 3D/4D imaging utilizes more power than 2D imaging.  Or as one physician warned his patient, “Be careful they use a very powerful light.”  Compared to the traditional ultrasound that we're all familiar with, these new ultrasound methods are not really a new technology, but rather a re-application of the same 2D ultrasounds. In order to produce a 3D image, the ultrasound device throws its sonic pulses at different angles, feeds the reflections into a computer, and a program renders the data in the form of a 3D image of your baby. The 4D version of this uses a similar process but without a delay between scanning and imaging. This improvement is what allows 4D ultrasounds to show patients what their baby looks like and is doing in real time.

My first request to image a malformation came from a local obstetrician.  He had a patient with a baby with bladder exstrophy.  At the time none of the perinatal units had 3D equipment.  The pediatric surgeon felt both the patient and he would benefit from seeing it in that manner. I did it for free.  I couldn’t fathom charging a family who was already facing enormous bills.  I didn’t advertise the service because I didn’t see the need till I met Patti from Alexandra’s house.  She called the office and asked my receptionist how much it would cost to image conjoined twins.  It was explained that I image malformation for free.  Patti came with the patient.  I was able to answer her questions, allow her to see her babies moved, show her their faces, beautiful hands and feet.  I knew nothing about this great perinatal hospice service we have in Kansas City.  I volunteered to help whenever the need arose.  I have had the great pleasure of serving Patti and Alexandra’s house since.  The families that are referred simply want the opportunity to see their baby and the malformation in a stress free environment and more clearly.

I currently own the most wonderful piece of equipment, GE Voluson E8 with HD live.  You will find this level of equipment only in perinatal departments.  I want to ensure quality diagnostic and patient requested exams.   The most recent advancement in transducer technology and the computer within allows me to create a more vivid image.

As an independent sonographer I am able to bend to the needs of your patients.   Please feel free to call and let me know about any special requests that need to be taken into consideration. I look forward to serving both you and your patients for many years to come.