Latest / MSKMag OutLoud / Focus on POCUS: Not as Black and White as It Looks

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Focus on POCUS: Not as Black and White as It Looks · MSKMag OutLoud

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  SPEAKER_00: Focus on Pocus, not as black and white as it looks.
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  SPEAKER_00: Written by Dominic Smith.
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  SPEAKER_00: Sponsored by PhysiQuip.
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  In the UK,
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  more clinicians are taking the plunge into MSK point-of-care
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  ultrasound.
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  SPEAKER_00: POCUS.
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  SPEAKER_00: The buzz is real.
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  SPEAKER_00: Some are seeing it as the modern MSK clinic's next essential tool,
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  SPEAKER_00: while others raise their eyebrows at how practical it truly is,
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  asking whether it is just another expensive thing we can charge
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  more money for.
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  SPEAKER_00: Either way, it's here and growing fast.
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  SPEAKER_00: Our social media feeds are showing packed out courses.
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  There are countless ads for devices and videos and images being
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  shared with a story
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  whilst we squint at these images pretending to know what
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  they're looking at.
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  SPEAKER_00: So what is the real story?
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  SPEAKER_00: How do you learn Pocus?
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  SPEAKER_00: What should you keep your eye on?
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  SPEAKER_00: We are going to go on a journey and look at it through three lenses.
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  SPEAKER_00: One, the beginner stepping into the unknown.
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  SPEAKER_00: Two, the educator guiding new learners.
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  Three,
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  and me,
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  the industry insider who's seen behind both the probe and the
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  sales pitch.
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  SPEAKER_00: So why are we talking about POCUS?
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  SPEAKER_00: We can't ignore it anymore.
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  SPEAKER_00: Diagnostic imaging as a whole is a staple part of our industry.
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  SPEAKER_00: Whether you are performing the scans or not,
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  SPEAKER_00: you will likely have referred someone for one at some point.
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  The wonderful aspect of POCUS is that it gives you real-time
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  dynamic imaging and
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  SPEAKER_00: elevates your diagnostic confidence.
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  Rob Bevan,
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  a chiropractor just starting out in ultrasound,
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  puts it like this.
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  My interest in exploring POCUS stems from a desire to enhance
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  diagnostic accuracy,
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  SPEAKER_00: clinical reasoning,
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  SPEAKER_00: and patient communication.
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  SPEAKER_00: In a busy clinic, Rob sees how timely imaging can change the play.
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  SPEAKER_00: Clarifying a working diagnosis,
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  SPEAKER_00: spotting red flags earlier,
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  SPEAKER_00: or simply helping patients visualise what we're thinking.
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  SPEAKER_00: For him, ultrasound isn't a replacement for skills, it's a step up.
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  SPEAKER_00: I see it as a way to strengthen my ability to form clear,
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  evidence-based management plans and improve patient confidence
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  in the process.
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  SPEAKER_00: Mike Bryant,
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  SPEAKER_00: a physiotherapist,
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  SPEAKER_00: sonographer and experienced educator,
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  SPEAKER_00: has watched the landscape dramatically change.
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  SPEAKER_00: He describes ultrasound as a technical skill of probe manipulation,
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  anatomical knowledge and pattern recognition – a skill that you
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  must master by
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  SPEAKER_00: doing,
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  SPEAKER_00: not watching.
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  SPEAKER_00: From my standpoint in the industry,
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  SPEAKER_00: being a sports therapist,
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  SPEAKER_00: BSC,
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  working within the device sales industry offers a rare insight
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  into how both worlds
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  SPEAKER_00: operate.
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  SPEAKER_00: Understanding the clinical nuances of using diagnostic ultrasound,
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  but also the business realities that clinics face when
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  investing in new technology,
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  SPEAKER_00: helps me to separate the hype from the helpful.
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  The sector is developing quickly with more models and
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  variations coming onto the
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  SPEAKER_00: market seemingly every week,
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  SPEAKER_00: and it is hard to keep track and hard to know who to trust.
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  SPEAKER_00: The reality check.
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  SPEAKER_00: Spoiler alert, POCUS isn't plug and play.
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  SPEAKER_00: I learned that very early on.
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  SPEAKER_00: Everything just looks the same at first.
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  SPEAKER_00: For beginners, the screen might as well be snow.
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  Rob expects a steep curve of understanding anatomy from an
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  ultrasound perspective,
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  SPEAKER_00: and he knows his consultations might slow down while he gets comfortable.
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  SPEAKER_00: Mike agrees.
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  The biggest misconception is that it's going to be an easy
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  process and that they'll
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  SPEAKER_00: be proficient after a couple of courses.
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  SPEAKER_00: He warns,
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  it takes time and dedication to grasp the probe skills and the
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  detailed anatomical
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  SPEAKER_00: knowledge.
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  SPEAKER_00: His useful tip is simple.
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  SPEAKER_00: Learn to scan normal anatomy before hunting pathology.
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  From the supplier's side,
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  I see how technology creates the illusion of ease.
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  SPEAKER_00: Handheld devices have made ultrasound look easy.
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  SPEAKER_00: You plug it into a tablet, start scanning, and it seems simple.
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  SPEAKER_00: But that simplicity can be misleading.
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  SPEAKER_00: Back in January 2023,
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  a UK qualitative study emphasized that POCUS implementation
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  faces challenges,
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  SPEAKER_00: including the need for proper training,
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  SPEAKER_00: education,
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  SPEAKER_00: and quality assurance frameworks.
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  Her proposed framework for MSK POCUS by physiotherapists
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  highlights the importance
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  SPEAKER_00: of integrated scope of practice,
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  SPEAKER_00: education and governance solutions.
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  The takeaway POCUS is a skill built with patience,
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  repetition and humility.
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  SPEAKER_00: We all begin with fuzzy images.
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  SPEAKER_00: It's the practice that sharpens the view.
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  SPEAKER_00: Mentorship, guidance, and the art of feedback.
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  SPEAKER_00: Here's what truly matters.
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  SPEAKER_00: The people you surround yourself with.
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  SPEAKER_00: Not just a flashy, fancy machine.
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  Rob's values training where there's a supportive,
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  structured training environment.
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  Small groups,
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  experienced tutors,
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  and plenty of low pressure scanning opportunities.
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  Mike has seen and guided many clinicians through the
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  educational pathway and has
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  SPEAKER_00: witnessed the evolution of courses.
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  SPEAKER_00: Initially,
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  there were very few courses you could attend to get close
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  supervision with experts,
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  SPEAKER_00: he recalls.
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  Now I try to keep sessions small and simple with as much
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  scanning time as possible.
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  SPEAKER_00: He designs his courses accordingly.
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  Learning in small sessions and going back to the same area and
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  scanning it again
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  SPEAKER_00: really helps,
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  SPEAKER_00: he says.
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  SPEAKER_00: He's a fan of the online two-minute video demos that you can pause,
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  SPEAKER_00: replay and practice at your own pace.
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  But he also reminds learners not to get fixated on diagnosing
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  the amazing tendon
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  SPEAKER_00: tear on day one.
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  The main challenge for most learners is getting regular
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  supervision and remembering
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  SPEAKER_00: to enjoy the process,
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  SPEAKER_00: not rushing to find pathology.
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  Most conditions I speak to care more about training and
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  educational support than
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  SPEAKER_00: features and benefits.
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  SPEAKER_00: For me,
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  SPEAKER_00: good suppliers aren't just selling a system,
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  they should help you on your journey and make sure you get the
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  most out of your
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  SPEAKER_00: investment.
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  SPEAKER_00: In short, learning POCUS is like planting a garden.
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  SPEAKER_00: You need good soil, regular water and some time.
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  SPEAKER_00: The seeds don't sprout overnight.
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  SPEAKER_00: The technology?
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  SPEAKER_00: A blessing or a distraction?
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  SPEAKER_00: Ultrasound tech has come a long way.
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  What once filled a room now fits in a backpack or even in your
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  back pocket.
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  Mike observes that this shift has enabled access to more MSK
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  clinicians and made
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  SPEAKER_00: the cost feasible for many more practices.
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  SPEAKER_00: But don't be fooled.
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  SPEAKER_00: From where I sit,
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  SPEAKER_00: yes,
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  SPEAKER_00: accessibility has exploded,
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  SPEAKER_00: which is great,
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  but aggressive marketing can make focus appear deceptively
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  simple to learn and lead
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  SPEAKER_00: you into a false sense of security.
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  I'm asked all the time,
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  do you have any demo units or what is your best price?
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  SPEAKER_00: I appreciate some are on a budget,
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  SPEAKER_00: but if that is your main concern,
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  SPEAKER_00: hang fire on your Pocus journey.
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  SPEAKER_00: Your focus above all else should be image quality.
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  SPEAKER_00: If you're new to Pocus, it's safe to say you will be...
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  SPEAKER_00: Shit.
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  SPEAKER_00: Try and cut costs.
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  SPEAKER_00: You may get a shit machine, meaning you will likely be double shit.
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  Simply,
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  if the image isn't clear,
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  everything else becomes harder and way more expensive.
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  SPEAKER_00: But consider the other side where Mike hits the nail on the head.
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  SPEAKER_00: The best probe slash device in the world cannot fix a bad operator.
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  SPEAKER_00: You must learn the craft before the tech.
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  SPEAKER_00: I also stress the responsibility to suppliers in this equation.
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  For me,
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  we are just as responsible for offering good care and services
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  to patients.
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  SPEAKER_00: Of course,
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  SPEAKER_00: we have sales targets to meet,
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  SPEAKER_00: but I have seen this blind the reps to just getting a sale done.
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  This short-sightedness risks compromising both clinician
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  confidence and patient
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  safety as clients may not be getting the appropriate system for
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  their needs or the
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  SPEAKER_00: necessary support and device training.
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  SPEAKER_00: So yes, join the tech revolution, but keep your brain switched on.
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  SPEAKER_00: This is not something to be rushed.
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  SPEAKER_00: Time, patience and realism.
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  SPEAKER_00: Here's what I tell newcomers.
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  SPEAKER_00: The biggest investment isn't money, it's time.
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  SPEAKER_00: Rob gets this.
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  SPEAKER_00: I know consistency will be key.
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  Building a mental library of normal appearances takes scanning
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  again and again.
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  SPEAKER_00: Mike has seen the drop off.
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  People come back after six months and realise they've forgotten
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  half of it.
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  SPEAKER_00: Keep the probe in your hand.
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  SPEAKER_00: Even five minutes a day matters.
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  SPEAKER_00: And from the business side,
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  SPEAKER_00: clinicians are great at asking for training,
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  SPEAKER_00: but considerably underestimate how much ongoing support they'll need.
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  SPEAKER_00: Ultrasound is a long-term investment.
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  SPEAKER_00: It isn't like Shockwave,
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  SPEAKER_00: where you can just buy a machine and go,
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  SPEAKER_00: you're buying into a new lifelong skill.
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  SPEAKER_00: In practice,
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  this may mean you have to squeeze in scanning sessions between
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  patients or grabbing
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  SPEAKER_00: your wife,
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  SPEAKER_00: husband,
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  SPEAKER_00: brother or mother to scan them.
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  Pro tip,
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  if practicing on family members,
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  keep them sweet and feed them with treats.
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  SPEAKER_00: Even years down the line,
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  it's good to practice to revisit the basics regularly and stay
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  humble when the
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  SPEAKER_00: images are muddy.
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  SPEAKER_00: Ethics, confidence and the limits of POCUS.
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  SPEAKER_00: The governance and ethics side of things comes into focus with POCUS.
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  SPEAKER_00: Who can you scan?
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  SPEAKER_00: What can you scan?
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  SPEAKER_00: What can you say slash not say?
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  SPEAKER_00: These are just some of the questions.
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  SPEAKER_00: Having more access means more responsibility.
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  SPEAKER_00: Rob is mindful of this.
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  It's about integrating findings meaningfully,
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  not scanning for scanning's sake.
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  SPEAKER_00: And Mike agrees.
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  SPEAKER_00: Penitions want to use it on every patient, but sometimes less is more.
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  SPEAKER_00: Ultrasound is a supplement, not the main event.
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  SPEAKER_00: POCUS comes after a subjective and objective assessment, not before.
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  SPEAKER_00: There's a fine line between being enthusiastic and being overconfident.
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  SPEAKER_00: The technology is improving faster than the regulations,
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  SPEAKER_00: which means clinicians need to act responsibly.
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  SPEAKER_00: Governance will catch up for sure,
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  SPEAKER_00: but in the meantime,
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  SPEAKER_00: as mentioned earlier,
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  SPEAKER_00: surround yourself with good people to help guide you.
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  SPEAKER_00: And again,
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  I stress the responsibility on those in the industry to know
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  the regulations and
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  SPEAKER_00: not pass it off as the responsibility of the clinician.
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  SPEAKER_00: We are in this together.
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  SPEAKER_00: Yes,
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  SPEAKER_00: you can do more with POCUS,
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  SPEAKER_00: but you all must also know when to stop,
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  SPEAKER_00: refer and seek a second opinion.
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  SPEAKER_00: where POCUS is heading.
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  SPEAKER_00: Looking ahead, I'm optimistic.
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  SPEAKER_00: POCUS use in the UK is growing fast, especially in private MSK practice.
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  AI features are already creeping in to help with image
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  interpretation and workflow.
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  SPEAKER_00: But beware, these fancy features can be a blessing and a curse.
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  SPEAKER_00: Remember Mike's wise words, you must learn the craft, not the tech.
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  Mike has seen how the community is growing as well and how it
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  is bringing people
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  SPEAKER_00: together and inspiring growth.
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  SPEAKER_00: Courses, workshops, peer groups, it's a community now.
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  SPEAKER_00: People learn faster when they share.
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  SPEAKER_00: Rob describes his own path.
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  SPEAKER_00: In the longer term,
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  I see ultrasound becoming an integral part of my professional
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  development and
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  SPEAKER_00: clinical identity.
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  It allows me to offer more precise assessments and communicate
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  findings visually with patients.
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  SPEAKER_00: In short, if you start this journey now, you're getting in early.
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  SPEAKER_00: This isn't just a shiny gadget.
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  You're investing in yourself and your patients and gearing up
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  to become part of how
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  SPEAKER_00: MSK clinics operate.
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  SPEAKER_00: Key takeaways from the three of us.
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  SPEAKER_00: One, prioritise the fundamentals.
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  SPEAKER_00: Probe handling, anatomy, pattern recognition.
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  SPEAKER_00: Two, be kind to yourself.
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  During the learning,
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  curved confidence will go up and down and that's okay.
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  SPEAKER_00: Three, commit to time and practice.
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  SPEAKER_00: Regular scanning and regular workshops beat one big weekend course.
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  SPEAKER_00: Four, have governance and a referral slash second opinion pathway.
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  SPEAKER_00: Pocus doesn't stand alone and you will need support.
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  SPEAKER_00: Five, buy cheap, buy twice.
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  SPEAKER_00: If you must, wait and save.
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  SPEAKER_00: Image quality is paramount.
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  SPEAKER_00: Skimp on the system, you skimp on the image.
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  SPEAKER_00: Don't be double shit.
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  SPEAKER_00: Final Reflections.
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  SPEAKER_00: POCUS isn't just about seeing what's inside a joint or a tendon.
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  SPEAKER_00: It's about curiosity,
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  SPEAKER_00: patience and learning how to interpret shades of grey,
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  SPEAKER_00: both literally and figuratively.
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  It's a tool that rewards time and humility where confidence
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  grows quietly through repetition.
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  SPEAKER_00: The first scans are often frustrating.
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  SPEAKER_00: Anatomy will look alien.
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  SPEAKER_00: The image drifts and changes.
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  SPEAKER_00: Even the simplest probe angle feels like a riddle.
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  SPEAKER_00: But as our three perspectives show,
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  SPEAKER_00: the beginner gains understanding,
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  SPEAKER_00: the teacher guides progress,
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  SPEAKER_00: and the industry insider brings perspective.
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  SPEAKER_00: At its best, POCUS doesn't replace assessment or instinct.
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  SPEAKER_00: It sharpens them.
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  SPEAKER_00: It helps conditions see what they've always known was there,
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  SPEAKER_00: only now with a bit more clarity and a lot more grey.