The Ultrasound Evangelist
Dr. Nilam Soni is an ultrasound evangelist. His love for point-of-care ultrasound started in medical school when he saw the possibilities beyond just the traditional uses in a few specialties.
“Traditionally people think of ultrasound and think of babies but we can use ultrasound to get answers to a myriad of questions without spending time, money, and do it at the point of care,” he said.
Dr. Soni believes that there is a huge technology gap in medicine. As a practicing internal medicine hospitalist at the South Texas VA Hospital and University Hospital, he has seen again and again the difference that using point-of-care ultrasound can make. He explained that advancements in technology are making ultrasounds more powerful, compact, and affordable. “There are handheld models that cost around $5000 and portable laptop style ones for $20,000. There’s even one that you can plug into your phone that leases for $200 per month. The technology is way beyond our use in medicine.”
“Traditionally we have used the stethoscope, a 200 year old rubber tube with diaphragm, and our hands to make important decisions, sometimes in life-threatening situations, about the care of patients,” he said. “Ultrasound allows you to see inside the body. The FAST exam, for example, lets you look in the belly for blood and if blood is seen, you can send the patient to the operating room immediately rather than waiting for CT scans or other tests.”
He explained a patient that had a profound impact on his views towards ultrasound when he was an intern.
“A man came in complaining of abdominal pain and his blood pressure was low. He was in a back room and didn’t speak English. I examined his belly and I felt a pulsatile mass. I knew that if this was an abdominal aneurysm that was rupturing, the man could die in seconds if we didn’t figure this out fast,” he said.
At this point, Dr. Soni took the portable ultrasound machine and saw a 9cm aneurysm (the normal size is 3cm). He rushed the patient to the front room, called the vascular surgeons who took the patient to the operating room. The patient survived and went home ten days later.
“The typical trajectory for this patient would have been to send him for a stat CT scan, and in the interim or while in the CT scanner, the patient would have coded and died. At that point I realized there has to be a better way to treat people and in this case, ultrasound saved the patient.”
As an ultrasound evangelist, he realized that most clinicians in the medical community were not aware of the benefits of point-of-care ultrasound. In his quest to spread the gospel of ultrasound, he knew that more data would be needed to prove the benefits of ultrasound, especially to convince the skeptics. He decided to pursue a Master in Science in Clinical Investigation here at the Graduate School of Biomedical Sciences.
“I realized early on that to change the way medicine is practiced, you’ve got to have evidence. In the master’s program, I looked at the implementation barriers for point-of-care ultrasound and we identified three critical care barriers—1) access to equipment, 2) training, and 3) physician beliefs.”
Besides dedicating time to clinical and health service research, he spends time training doctors how to use ultrasound. To help train medical students and others, Dr. Soni wrote a book, Point-of-Care Ultrasound, a handbook for physicians or any health care practitioners looking to further their knowledge and skills in point-of-care ultrasound. The book has been translated into Chinese and Spanish and won a British Medical Association book award. He is currently working on the second edition.
“Doctors in China were so excited because they told me that they don’t get access to books like this one,” he said. “The bonus of the book is you get online access to cases and around 300 videos.”
Dr. Soni didn’t always know that he would be a doctor. He was studying pharmacy and working part-time as a flight instructor, but it wasn’t until a mission trip that solidified his decision to pursue medicine. “It was such a gratifying experience to help people and I realized what a big impact we could have on people’s lives. Giving medications to people is one thing but educating them about their disease is key.”
In January 2010, Dr. Soni went to Haiti shortly after the earthquake. “My wife and I had a six week old baby, and she turned to me and said you should go,” he said. While he was at the main hospital in Port-au-Prince, he became the ultrasound person for the hospital because of his expertise.
Dr. Soni is a currently a clinician, a researcher, and an active member of several professional organizations, including the Society of Hospital Medicine, American College of Chest Physicians, and American Institute for Ultrasound in Medicine. He is the director for point-of-care ultrasound training in the VA Health Care system and after completing the Master in Science in Clinical Investigation, he has awarded a health service research grant to evaluate the implementation of point-of-care ultrasound in the VA system.
“The benefits of the ultrasound can be best shown in an integrated healthcare system like the VA System,” he said.
To future students, he had this advice.
“A lot of life is just self-realization—-you start out being interested in something and then that interest grows until you just find your calling. For me, it was point-of care ultrasound,” he said.
“I would say to students interested in pursuing medicine, just do it. Don’t get discouraged. You can make a difference, even if you are just one person.”