Missed Pathology
Hi all,
I’m currently still a student, about 2 months out from graduation. I’ve been working on building my confidence to eventually be able to scan independently, and I feel I’ve been doing really well. The techs I scan with make comments like “You don’t really need us there, you’re doing so well!”, etc. One tech in particular, I’ll call her Sam, has been very chill when I scan and tells me not to overthink things and to trust myself. There have been multiple times I’ve scanned with her where I point something out that looks odd to me and she says it’s normal and not to overthink it. I measured what I thought was a discreet thyroid nodule one day and she backscanned and told me she thought it was just part of a larger nodule, so we deleted my images that characterized it as a solitary nodule. Little things like that.
All of this being said—I’ve been working to make more independent judgement calls when I scan, and to “not overthink” when I am scanning.
Fast forward to last Wednesday. Sam and I went to scan a pelvic on a patient with AUB. I insert the TV probe and see a large, complex nabothian cyst almost immediately. I take my images of the uterus, move on to cervix, document the large nabothian, and also notice some echogenic material in the endocervical canal. I throw on color and interrogate, trying to make sure I don’t see a vascular stalk. All good there. Finally, as I’m doing sweeps, I notice some asymmetry to the cervix. The left side looks a little heterogeneous, almost like it has tiny calcs in it, and looks “fuller” than the right side. I sweep through in long and trans, but I’m not seeing super discrete borders on anything… huh. Sam is behind me observing, and doesn’t say anything. In my head, I’m thinking “Don’t overthink it…”, so I move on and complete the rest of the exam. As I’m getting ready to end it, Sam stops me and says we need to take more pictures. She tells me to go to the cervix, and then points at the area I’d been looking at earlier, saying “You need to measure THAT and take cines.” I immediately knew what she was talking about (the weird area!) and went through and documented. Now that she had pointed it out as abnormal, I noticed I was using a bit more probe pressure and I felt I could make out borders better in the area.
After the exam, Sam seemed disappointed. She asked me “What HAPPENED?”, and I was just kind of flustered and I told her “I feel like the area looked weird,” and she said “Yeah it looked weird! She had a giant mass on her cervix! What was going through your mind when you scanned that?” And I explained that I thought it looked funky but I wasn’t seeing discrete borders. She said “It’s okay, that’s why I’m here.” I felt awful. This is someone I really respect who used to tell me she felt I could scan on my own no problem.
This situation really shook me to my core. The bit of confidence I thought I was building has been really shot, and every time I think about the situation, I feel awful. Later in the day, Sam asked me how I was doing and I told her I was feeling awful about not catching the path from earlier. She reassured me and told me we all make mistakes and have missed things, and not to beat myself up over it, that she didn’t mean to make me feel badly. I just can’t help but feel incompetent now. How did I miss identifying something that Sam so clearly saw as a “giant mass”?
In the moment, looking back, I see I should’ve done a few things differently:
- Spent more time interrogating the area I thought looked abnormal, of course.
- Being uncertain if it was abnormal, I should have asked Sam in the moment what she thought of the area before moving on.
- Taken full responsibility for the exam rather than expecting Sam to intervene if she thought I was missing an abnormality.
Have you missed path before? What did you feel and how did you move forward? How can I work to rebuild my confidence as I’m approaching graduation?
Thank you for reading!