Again I understand how you feel but it not the reality. A consultation is
very different thing from sending in a blood test to be analysed. I do not
know how many blood tests you do in your lab per day but no physician in
this world does 1/1000 that of consultations per day. A phone call is a
consultation, however short, but not a requisition for blood tests. We have
a very vital role to play but it is not in being so negative about medics.
When I looked at the responses to this issue. 90% jumped on the same
anti-medic bandwagon. Our work is important and vital but it is not the
same as a junior doctor facing the stresses of the ED or an acute
medical/surgical ward. We need to realise that we are a support service,
not the ordering service. We are a compliment in the same way radiology and
pathology are. Anyone who knows me would never see me as a 'yes' person who
see my lab as a black box with no interaction with the ordering doctors. I
see myself as an integral part of patient care but I do not see myself
turning down requests for tumour markers because they come from the ED. No
request in my lab is turned down without talking to the ordering physician
and with documentation by the biochemist as to why. However, if after 3
attempts to contact said physician has failed a note is sent stating the
serum is frozen and will be kept in the fridge for one month after which it
will be thrown out unless the lab is contacted by the ordering physician. I
like to give them the benefit of the doubt. I also think that those of us
who are actively involved in patient care outside the lab are more
successful than those who do not leave the lab. This does not mean they
have to be physicians as was well illustrated by the group who worked with
the ED to decrease ID errors and did not just laugh at the ED doctors
errors. If one feels that requisitions are not reflecting the tests being
ordered and it is important that clinical data is filled in (which I do
not) then it reflects a failure on our behalf because we have not taught
and convinced the doctor to do what we want and why. If they gain something
worthwhile from taking the trouble then they will do it.
All I can say is we should get out of our labs and understand the people we
are there trying to help. I am not saying that lab professionals are not
working hard trying to help it is just we are going about it in a not very
effective manner if we stay in the lab
As always
Elizabeth Mac Namara
At 11:01 AM 26/10/04, Mainwaring-Burton Richard (RGZ) wrote:
>This takes us back to the "what is a request?" discussion and also invokes
>the "what is a laboratory" discussion.
>
>In my view, a laboratory request should be a consultation and not a demand,
>since we have (or should have) so much more to offer than numbers on paper -
>yes, even to the point of looking after patients' best interests. The
>laboratory is a laboratory and not a black box. I agree that we want to look
>after patients, but the black box mentality will encourage our frontline
>colleagues to ignore the consultative benefit of experienced laboratory
>staff.
>
>with best wishes
>
>Richard
>
>Richard Mainwaring-Burton
>Consultant Biochemist
>Queen Mary's Hospital
>Sidcup, Kent
>DA14 6LT
>020-8308-3084
>
>
>-----Original Message-----
>From: Elizabeth Mac Namara [mailto:[log in to unmask]]
>Sent: 26 October 2004 15:04
>To: Mainwaring-Burton Richard (RGZ); [log in to unmask]
>Subject: Re: It makes you wonder
>
>
>Interestingly enough I feel the opposite to you and I think it reflects the
>divide between those who look after patients and those who do not. First of
>all the diagnostic information on a request is next to useless. On any
>given patient there are many reasons for doing even a U&E let alone the
>multiple tests ordered. The patient may be on diuretics for hypertension,
>an ACE because they have diabetes, which do you fill in diabetic, on ACE or
>on diuretics. A patient like this is easy and you have not yet looked at
>the presenting complaint. It is a waste of time and impossible to fill in
>anything other than the minimum which is why I do not ask it except for
>certain tests such as ESR.
>
>In the event you arrived at the ER with a dog bite and the doctor noticed a
>lump, a high blood sugar, a pleural effusion on examination etc. would you
>like him/her to do more than suture your bite and give you a tetanus
>injection? Maybe you think it best you get sent back to your GP with a
>letter to be dictated and typed some time in the future to start any
>investigation? I would not. Nor would your Medical Protection company. It
>behoves any physician to act on information they find, whether or not it is
>related to the presenting complaint. I do understand there is a great
>waste in medicine but I also feel we should clean up our own back yard
>before we start berating others who carry a heavier burden than us.
>
>Elizabeth Mac Namara
>
>At 06:49 AM 26/10/04, Mainwaring-Burton Richard (RGZ) wrote:
> >Analysis of HbA1c on an A&E sample is hard to justify and would be regarded
> >by me as a waste of resources, even with the undoubted justification of a
> >dog bite.
> >I apply the same principle to tumour markers, Lipids and TFTs. These tests
> >are only available with consultation regarding special cases, since the A&E
> >staff are not going to influence or act on the results within 4 hours that
> >is if they have even got them by the time the patient has to be out of A&E.
> >
> >with best wishes
> >
> >Richard
> >
> >Richard Mainwaring-Burton
> >Consultant Biochemist
> >Queen Mary's Hospital
> >Sidcup, Kent
> >DA14 6LT
> >020-8308-3084
> >
> >
> >-----Original Message-----
> >From: Williams David G (RLN) City Hospitals Sunderland - Clinical
> >Scientist [mailto:[log in to unmask]]
> >Sent: 26 October 2004 11:39
> >To: [log in to unmask]
> >Subject: Re: It makes you wonder
> >
> >
> >Zinc wasn't asked for! Everything else was though - the bloods were taken
> >while the patient was in A&E
> >
> >-----Original Message-----
> >From: David Brown [mailto:[log in to unmask]]
> >Sent: 26 October 2004 11:31
> >To: [log in to unmask]
> >Subject: Re: It makes you wonder
> >
> >
> >I think it was because the patient was taking zinc
> >supplements to aid wound healing an dthe medic thought
> >this would affect her HbA1c
> >This is an abstract from a paper
> >
> >"The urinary excretion of zinc in individuals with
> >insulin-dependent diabetes mellitus (IDDM) is
> >approximately doubled. In the absence of a
> >compensatory mechanism, this hyperzincuria should
> >induce a deficient or marginal Zn status. We examined
> >parameters of Zn status in plasma and in blood cells
> >with respect to urinary Zn losses and Zn
> >supplementation. We measured Zn levels in the urine,
> >plasma, and erythrocytes of 14 IDDM subjects and 15
> >nondiabetics who kept dietary records for 3
> >consecutive days. Subsequently, six IDDM subjects and
> >seven nondiabetics were supplemented with 50 mg Zn
> >daily for 28 days. We measured the above parameters,
> >as well as mononuclear leukocyte Zn (MNL-Zn) and the
> >plasma subfraction of albumin-bound Zn (alb-Zn). The
> >total plasma Zn-binding capacity was also assessed.
> >Plasma copper and erythrocyte Cu were monitored as
> >indicators of potential Zn toxicity. Individuals with
> >IDDM displayed the expected hyperzincuria, but had
> >normal blood Zn parameters. Zincuria increased by a
> >similar amount in both groups during supplementation,
> >as did the MNL-Zn content. However, erythrocyte Zn
> >(e-Zn) was refractory, so a trend toward lower e-Zn
> >among IDDM subjects persisted during Zn
> >supplementation. Hemoglobin A1c (HbA1c) increased
> >markedly in the Zn-supplemented IDDM group. Despite
> >their chronic hyperzincuria, individuals with IDDM
> >appear not to be Zn-deficient. Large-dose Zn
> >supplementation increases MNL-Zn and induces an
> >undesirable elevation of HbA1c in all individuals.
> >This is especially disconcerting for those with IDDM,
> >and may reflect an exacerbation of a chronic "Zn
> >diabetes." These data suggest a potential for toxicity
> >from large-dose Zn supplementation"
> >
> >
> >David Brown
> >
> >
> >
> >
> >--- Martin Holland <[log in to unmask]>
> >wrote:
> > > That must have been a HUGE bite. Sure it was not a
> > > shark?
> > >
> > > :-)
> > >
> > > Martin.
> > >
> > >
> > > -----Original Message-----
> > > From: Williams David G (RLN) City Hospitals
> > > Sunderland - Clinical
> > > Scientist [mailto:[log in to unmask]]
> > > Sent: 26 October 2004 10:26
> > > To: [log in to unmask]
> > > Subject: It makes you wonder
> > >
> > >
> > > Request for HbA1c (which was normal) - clinical
> > > details "Dog Bite left arm"
> > >
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> >=====
> >David G Brown
> >Valencia
> >Espaņa
> >Tel 00 34 96 328 7207
> >mov. 00 34 676064278
> >e-mail [log in to unmask]
> >http://www.proz.com/pro/56276
> >
> >
> >
> >
> >
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