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Brief lab rant - stupid docs
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| John Gentile 2005-05-18, 11:23 am |
| I just have to add a rant over something that happened today. A patient came
in to our ER with a complaint of malaise, weakness, "green sputum", no
fever. He apparently is a recovering alky, no drug use, many many trips to
the ER for vague symptoms. Previous labs were pretty much normal, hiv neg,
lyme neg, rpr non reactive. No hx of travel.
The doc sent up a full battery of stuff (as he usually does) including
cardiac, troponin I, EtOH, dau screen and a request for Q fever and Brucella
antibodies. He claims that he consulted with Infectious Disease. He did have
a WBC of 11.3 with 70% grans. It appears that something is going on!
He never did order a blood culture or a sputum culture! I told the
pathologist that this guy is out of control and he's now not looking for
zebras, but now he's going after Eohippus! I suggested that we hold this
specimen until we hear directly from an ID doc, but it got sent out to
Quest.
The patient was given a PPD and sent home! I really hope our path goes after
this guy. He's already tracking his ordering of troponins, BNPs and blood
cultures without medical indication of doing so. I just needed to rant!
--
John Gentile MS M(ASCP) yjgent@cox.net
Laboratory Information, QA Manager
VA Medical Center
Providence, RI
The contents of this message are mine personally and do not reflect any
position of the Government or VA.
| |
| Katra 2005-05-18, 11:23 am |
| In article <BEA99243.18F9A%yjgent@cox.net>,
John Gentile <yjgent@cox.net> wrote:
> I just have to add a rant over something that happened today. A patient came
> in to our ER with a complaint of malaise, weakness, "green sputum", no
> fever. He apparently is a recovering alky, no drug use, many many trips to
> the ER for vague symptoms. Previous labs were pretty much normal, hiv neg,
> lyme neg, rpr non reactive. No hx of travel.
>
> The doc sent up a full battery of stuff (as he usually does) including
> cardiac, troponin I, EtOH, dau screen and a request for Q fever and Brucella
> antibodies. He claims that he consulted with Infectious Disease. He did have
> a WBC of 11.3 with 70% grans. It appears that something is going on!
>
> He never did order a blood culture or a sputum culture! I told the
> pathologist that this guy is out of control and he's now not looking for
> zebras, but now he's going after Eohippus! I suggested that we hold this
> specimen until we hear directly from an ID doc, but it got sent out to
> Quest.
>
> The patient was given a PPD and sent home! I really hope our path goes after
> this guy. He's already tracking his ordering of troponins, BNPs and blood
> cultures without medical indication of doing so. I just needed to rant!
Heh.
My favorite pet peeve happened again today...
Ortho's that don't anticipate blood loss in elderly patients.
In this case, a bilateral knee replacement. :-P
Ordered a pre-op type and screen only.
Dude came out of surgery with a 6.5 gram hemoglobin.
Stat crossmatch anyone? <lol>
Drives me BONKERS!
Helluva way to start my shift..... and he had to be re-drawn since he'd
not been banded initially so the doc got all t'd off about that, but I'd
anticipated what was going to happen so started setting up my tubes and
stuff while the phlebotomist went to do the re-draw. It caused maybe a 5
minute delay, tops. ;-)
Failure to plan on their part is always the lab's fault, right???
--
K.
Sprout the MungBean to reply
"I don't like to commit myself about heaven and hell--you
see, I have friends in both places." --Mark Twain
| |
| Manky Badger 2005-05-18, 11:23 am |
|
"Katra" <KatraMungBean@Centurytel.net> wrote in message
news:KatraMungBean-BA4E8A.00195713052005@corp.supernews.com...
> Failure to plan on their part is always the lab's fault, right???
We are not here to provide test results.
We are here to take the blame !
MB
| |
| Katra 2005-05-18, 11:23 am |
| In article <d61hs8$prh$1@newsg4.svr.pol.co.uk>,
"Manky Badger" <spam@puritanDOTfreeserve.FULLSTOPcoSPOTuk> wrote:
> "Katra" <KatraMungBean@Centurytel.net> wrote in message
> news:KatraMungBean-BA4E8A.00195713052005@corp.supernews.com...
>
>
> We are not here to provide test results.
> We are here to take the blame !
>
> MB
>
>
:-P
Fortunately, a later experience tonight made me feel a bit better...
Had an outpatient infant with a critical value. The Doc was from out of
town and had not bothered to include a phone number with the orders, and
was not in our computer system. Between trying to keep up with the rest
of the work and trying to track him down, I finally got ahold of him 2
1/2 hours later thru his answering service and that took 3 calls. ;-)
I had to call the patient's family to get the office phone number and
they were not home initially. I just HATE doing that because it nearly
always spooks them. I just told them, truthfully, that I needed the
doctors information so we could make sure his office got the results.
I commented wryly to the doctor when he finally called me back that he
was a difficult man to get ahold of, then gave him the results. He asked
for the others, (there were several tests), then THANKED me for taking
the time and trouble to let him know.
Little things like that can sometimes make it all worthwhile eh?
It's nice to be appreciated for the efforts from time to time.
A simple "thank you" can mean so much!
--
K.
Sprout the MungBean to reply
"I don't like to commit myself about heaven and hell‹you
see, I have friends in both places." --Mark Twain
| |
| kuhnfucius 2005-06-21, 10:54 pm |
| Hey, John. Have not been here in a long time. Mind if I rant on in? OK,
thanks. My uncle had shingles last year and a local (older) Dr. reported
him to the CDC as a possible case of small pox????????????
Bye the way I often have cases where I assume a blood culture was ordered
and sure to grow something, only to find none were ordered. This would be
the one case out of the last twenty (where ewverthing was normal) that blood
cultures were ordered Go figure.
------------------------------------------------------
My standard reply: "I am give top priority to your test request and have my
best technician working on it......it is on my microscope now, next in
line....absolutely....bye....
Now where did I put it?
"John Gentile" <yjgent@cox.net> wrote in message
news:BEA99243.18F9A%yjgent@cox.net...
>I just have to add a rant over something that happened today. A patient
>came
> in to our ER with a complaint of malaise, weakness, "green sputum", no
> fever. He apparently is a recovering alky, no drug use, many many trips to
> the ER for vague symptoms. Previous labs were pretty much normal, hiv neg,
> lyme neg, rpr non reactive. No hx of travel.
>
> The doc sent up a full battery of stuff (as he usually does) including
> cardiac, troponin I, EtOH, dau screen and a request for Q fever and
> Brucella
> antibodies. He claims that he consulted with Infectious Disease. He did
> have
> a WBC of 11.3 with 70% grans. It appears that something is going on!
>
> He never did order a blood culture or a sputum culture! I told the
> pathologist that this guy is out of control and he's now not looking for
> zebras, but now he's going after Eohippus! I suggested that we hold this
> specimen until we hear directly from an ID doc, but it got sent out to
> Quest.
>
> The patient was given a PPD and sent home! I really hope our path goes
> after
> this guy. He's already tracking his ordering of troponins, BNPs and blood
> cultures without medical indication of doing so. I just needed to rant!
>
> --
> John Gentile MS M(ASCP) yjgent@cox.net
> Laboratory Information, QA Manager
> VA Medical Center
> Providence, RI
>
> The contents of this message are mine personally and do not reflect any
> position of the Government or VA.
>
>
>
>
| |
| JEDilworth 2005-06-22, 10:52 pm |
| I find that most general docs' knowledge of microbiology is totally
pathetic. That confirms it for me. How absolutely ridiculous!
Hopefully it gave CDC a good laugh after giving them a near heart attack
first....
Judy Dilworth, M.T. (ASCP)
Microbiology
"kuhnfucius" <krkuhn@adelphia.net> wrote in message
news:S-ednR6Iu_sYPyXfRVn-1Q@adelphia.com...
My uncle had shingles last year and a local (older) Dr. reported
him to the CDC as a possible case of small pox????????????
| |
| First of Three 2005-06-23, 9:00 am |
| "JEDilworth" <bactitech@nospamhortonsbay.com> wrote in message
news:LuWdnSQgYpg0cCTfRVn-3A@buckeye-express.com...
> I find that most general docs' knowledge of microbiology is totally
> pathetic. That confirms it for me. How absolutely ridiculous!
>
> Hopefully it gave CDC a good laugh after giving them a near heart attack
> first....
>
> Judy Dilworth, M.T. (ASCP)
> Microbiology
>
> "kuhnfucius" <krkuhn@adelphia.net> wrote in message
> news:S-ednR6Iu_sYPyXfRVn-1Q@adelphia.com...
> My uncle had shingles last year and a local (older) Dr. reported
> him to the CDC as a possible case of small pox????????????
But on ER you see the junior docs doing Gram's stains.
| |
| Katra 2005-06-23, 11:54 am |
| In article <d9eb1i$sl$1@domitilla.aioe.org>,
"First of Three" <firstofthree@yahoo.co.uk> wrote:
> "JEDilworth" <bactitech@nospamhortonsbay.com> wrote in message
> news:LuWdnSQgYpg0cCTfRVn-3A@buckeye-express.com...
>
> But on ER you see the junior docs doing Gram's stains.
>
>
Mmmmm... It's rare, but we have had a couple of docs come into the lab
to do exactly that. I do the staining for them, but they do the looking.
We have one Urologist especially that will come in and do that, as well
as one plastic surgeon. A few of the OB-Gyn's will also come in and do
their own wet preps. One ER doc will do that also.
And these are not junior dudes. ;-)
Cheers!
--
K.
Sprout the MungBean to reply
"I don't like to commit myself about heaven and hell‹you
see, I have friends in both places." --Mark Twain
| |
| JEDilworth 2005-06-23, 5:55 pm |
| I can see urologists doing smears as they read many of their own urine
microscopics in their offices (at least my mother's urologist's office
does).
At teaching hospitals it is very common for the infectious disease docs
to come in and look at smears. This doesn't happen very often at
non-teaching institutions.
I think it's a riot that they have doctors performing incredibly
esoteric testing on the TV show "House." The show is interesting, but
the fact that they work in these dingy dark labs with no one else around
doing complicated weirdo tests that are always send-outs is a real hoot.
It's also interesting that they get results within minutes!
Judy Dilworth, M.T. (ASCP)
Microbiology
| |
| Katra 2005-06-27, 10:00 am |
| In article <YPedneqoDOJGtibfRVn-qw@buckeye-express.com>,
"JEDilworth" <bactitech@nospamhortonsbay.com> wrote:
> I can see urologists doing smears as they read many of their own urine
> microscopics in their offices (at least my mother's urologist's office
> does).
>
> At teaching hospitals it is very common for the infectious disease docs
> to come in and look at smears. This doesn't happen very often at
> non-teaching institutions.
>
> I think it's a riot that they have doctors performing incredibly
> esoteric testing on the TV show "House." The show is interesting, but
> the fact that they work in these dingy dark labs with no one else around
> doing complicated weirdo tests that are always send-outs is a real hoot.
> It's also interesting that they get results within minutes!
>
> Judy Dilworth, M.T. (ASCP)
> Microbiology
>
Oh yeah! <lol>
Totally unrealistic TAT's!
--
K.
Sprout the MungBean to reply
"I don't like to commit myself about heaven and hell‹you
see, I have friends in both places." --Mark Twain
| |
| Manky Badger 2005-06-27, 10:00 am |
|
"JEDilworth" <bactitech@nospamhortonsbay.com> wrote in message
news:YPedneqoDOJGtibfRVn-qw@buckeye-express.com...
>I can see urologists doing smears as they read many of their own urine
> microscopics in their offices (at least my mother's urologist's office
> does).
>
> At teaching hospitals it is very common for the infectious disease docs
> to come in and look at smears. This doesn't happen very often at
> non-teaching institutions.
>
> I think it's a riot that they have doctors performing incredibly
> esoteric testing on the TV show "House." The show is interesting, but
> the fact that they work in these dingy dark labs with no one else around
> doing complicated weirdo tests that are always send-outs is a real hoot.
> It's also interesting that they get results within minutes!
Here in the UK there's an increadibly populat TV series called "Casualty"
which the masses seem to love (!). One particularly thick junior doctor was
reprimanded by a superior and was told he'd "be lucky to end up in a path
lab"
| |
| mpmorin 2005-08-13, 8:55 am |
| Ok, I have a problem with docs doing their own testing. I connect it with
POCT. Docs and RNs and LPNs don't know diddley about lab technology. They
don't care about quality control and preservation of specimens and specimen
integrity. At my hospital, I do not trust any nurse to do any kind of POCT.
They demand an 8year old boy to be stuck 3 times because they can't decide
what they want to collect. collect #1 - Emerg. profile. collect #2 -
Ammonia and extra tubes for unknown send-outs. Ammonia ends up getting
cancelled collect #3 - they figured out what they wanted - Plasma Amino
Acids and urine amino acids and Lactic Acid and another Ammonia.
The off-shift supervisor keeps putting signs up in the lab drop-off bucket
in the ED to let staff know that urinalysises must be done within 2 hours at
room temp. The staff ignored the sign two times and had a paper saying to
hold urine. one urine was picked up at 2300hrs with a collection time of
1850. duh!
"Katra" <KatraMungBean@Centurytel.net> wrote in message
news:KatraMungBean-0FB518.09505423062005@corp.supernews.com...
> In article <d9eb1i$sl$1@domitilla.aioe.org>,
> "First of Three" <firstofthree@yahoo.co.uk> wrote:
>
>
> Mmmmm... It's rare, but we have had a couple of docs come into the lab
> to do exactly that. I do the staining for them, but they do the looking.
> We have one Urologist especially that will come in and do that, as well
> as one plastic surgeon. A few of the OB-Gyn's will also come in and do
> their own wet preps. One ER doc will do that also.
>
> And these are not junior dudes. ;-)
>
> Cheers!
> --
> K.
>
> Sprout the MungBean to reply
>
> "I don't like to commit myself about heaven and hell > see, I have friends
> in both places." --Mark Twain
| |
| Shylirin 2005-08-14, 8:53 am |
| It's not the competent physicians I worry about... it's the ones like the
Urgent Care Clinic doc that storms into the lab, demands to know who looked
at the wet prep he just got a report on, and then demands to see it on the
'scope himself. Whereupon he finds a Squamous Epithelial that's a bit
pointy on one end and wants to know why we couldn't identify that
Trichomonas! This was followed by me trying to explain what Trichomonas was
and why the Squamous wasn't one without fanning the fire, so to speak.
What about the Pediatrician who wants to see a peripheral smear, then looks
at the thick end of the smear and says he sees Monocytes, and follows that
up with a request for a Mono Test?  LOL!
Shylirin
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