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I too disagree completely with this. As laboratory professionals and "experts" it is our job, and our duty, to ensure we provide the right test at the right time on the right patient and provide the right interpretation. Neglecting these basic principles in effect makes our laboratories simply number crunching factories and certainly, in Carter terms, is not consistent with the current "end to end quality service" that UK pathology is aspiring to provide. Good debate Best wishes Ian Barlow UK -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Hallworth Mike (RLZ) Sent: 30 June 2009 09:29 To: [log in to unmask] Subject: Re: CA-125 I disagree completely with this! The objective is to improve healthcare, not to run labs efficiently for their own sake. If an intervention saves costs elsewhere, improves outcome or reduces stress (and I accept that the "if" is crucial), we should be doing it. Mike -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of COLLINS MICHAEL (RM1) Norfolk and Norwich University Hospital Sent: 29 June 2009 17:53 To: [log in to unmask] Subject: Re: CA-125 Another factor to consider in this discussion is that using highly paid staff to screen requests, even when justified, costs more than doing the test in most cases. Holding on to samples for two weeks then discarding them is also wasteful of staff time. If an unnecessary test results in the patient more unnecessary and possibly expensive and stressful tests it is the fault of the original requester not the lab. Mike Collins BMS3 Biochemistry Automation Norfolk & Norwich University Hospital England http://www.nnuh.nhs.uk/ -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Elizabeth MacNamara Sent: 29 June 2009 16:28 To: [log in to unmask] Subject: Re: CA-125 I understand your logic but how do you know the test is irrevelant. Your method of deciding the test is useless is to put in place a hurdle the doctors have to jump over in order to get a test they want. I believe that is what is happening and while it is effective At reducing tests and costs I do not believe it is a correct course. The fact it protects the lab from legal problems is not what is at issue. It is a question of decreasing tests by ensuring the doctor must make an extra step and the lab knows that most won't because they are too busy to do so. I do not believe anyone has ever looked if this is a way of differentiating appropriate from inappropriate tests. So how can it be scientific to use such a shotgun method even if it is cheap. I know I personally believe automated cancelling of tests such as CA-125 is not a scientific way of ensuring patients get the right test done. Elizabeth Mac Namara On Jun 29, 2009, at 10:15 AM, "Hallworth Mike (RLZ)" <[log in to unmask] > wrote: > What we do works well. As I said, I don't cancel anything - I ask for > more information. The clinician then calls back when it suits her, > which they much prefer to being called by me in the middle of a busy > clinic. > And yes, if a clinician had ordered a bunch of irrelevant tests on my > mother, I would be delighted if the lab questioned them, as I know the > distress that can be caused by inappropriate testing. I wish it had > happened more often in the time leading up to her death. > > Mike > > > > > > -----Original Message----- > From: Elizabeth MacNamara [mailto:[log in to unmask]] > Sent: 29 June 2009 14:43 > To: Hallworth Mike (RLZ) > Cc: [log in to unmask] > Subject: Re: CA-125 > > I find this practice a little strange. If the doctor learns to write > information on the requisition that is 'appropriate' then she can have > the test. If she phones back within two weeks she can have the test > done for the patient This practice is based on which study to show > that these CA-125 were the high risk patients and all the other serum > samples were inapproriate. > > If you are NOT going to do a test ordered by someone who has actually > seen your wife or mother don't you think you should talk to them > first. > Would you really agree to it being cancelled in this way if the > patient was a relative. I would be very upset if it was me because i > would feel it was a ruse to reduce the test numbers rather than doung > what is best for the patient and I do understand the number of false > positives and negatives out there. > > Elizabeth Mac Namara > > > > On Jun 29, 2009, at 9:03 AM, "Hallworth Mike (RLZ)" > <[log in to unmask] > wrote: > >> In response to Tim's point on this - we would never say we >> refused/declined a request. >> We would say we did not think it was justified on the clinical >> information supplied, but we will hold the specimen for two weeks and >> would be happy to process it if clinical considerations warrant it >> and > >> they give us a ring. >> >> It puts the ball back in their court - very few get in touch, and if >> they ring and explain, we would do the test. I agree with Tim that if >> you refuse to do a test that a clinician clearly says they want, you >> are on pretty dodgy ground. But I think asking for further >> information > >> is quite justifiable. >> >> Mike >> >> >> >> >> >> -----Original Message----- >> From: Clinical biochemistry discussion list >> [mailto:[log in to unmask]] On Behalf Of EDWARD KEARNEY >> Sent: 29 June 2009 13:41 >> To: [log in to unmask] >> Subject: Re: CA-125 >> >> I would also decline the request. I would suggest that if malignancy >> is suspected then the patient should be on the appropriate cancer >> pathway. >> This may lead to a CA 125 but not in isolation. >> Best wishes, >> Edward >> >>>>> "Bradbury Wayne (RNL) North Cumbria University Hospitals" >> <[log in to unmask]> 29/06/2009 10:13 >>> Hello >> all, >> >> >> >> Is anybody else seeing a surge in requests from primary care for >> CA-125 >> on women >> >> with "Abdominal bloating ?ovarian malignancy?" >> >> >> >> I think this is related to an article in the BMJ on 4th June where a >> patient suggests her late >> >> diagnosis of ovarian cancer could have been prevented if only her GP >> had asked for a CA-125. >> >> >> >> http://www.bmj.com/cgi/content/full/338/jun04_2/b2072 >> >> >> >> I am declining these requests. Am I wrong? >> >> >> >> Wayne Bradbury. >> >> >> >> Mr WH Bradbury >> Consultant Biochemist >> Biochemistry Department >> Cumberland Infirmary >> CARLISLE >> Cumbria >> CA2 7HY >> Tel: 01228 814521 >> Fax: 01228 814831 >> E-mail: >> [log in to unmask]<mailto:wayne.bradbury@ncumbria- >> acut >> e.nhs.uk> >> >> >> >> ------ACB discussion List Information-------- This is an open >> discussion list for the academic and clinical community working in >> clinical biochemistry. >> Please note, archived messages are public and can be viewed via the >> internet. 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Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the originator of the message. This footer also confirms that this email message has been scanned for the presence of computer viruses but this should not be relied upon as a guarantee that the contents are virus free. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of the Norfolk and Norwich University Hospitals NHS Foundation Trust. 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Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/