Comments on: Hornets’ Nest

By: Dr Mark

Dr Mark — Sat, 22 Aug 2009 11:21:15 +0000

While I agree with your overall points on labs and the level of detail we provide to patients, I personally would have trouble characterizing a GFR estimated to be 50 as “normal kidney function”. If that is a stable creatinine, the GFR estimate suggests the creatinine is NOT normal for the patient’s age, even if the creatinine line lists it as being in the “normal range.” It may not change anything I do with the patient in the short or medium term, but I just can’t call that Cr normal and feel like I am being completely honest with the patient.

By: Rob

Rob — Sat, 22 Aug 2009 10:48:54 +0000

Agreed, Margaret. We are used to the background abnormals. We have anew PA and I am still telling her “Just ignore that one. It’s really not important.” If I have to say that to a PA, then I’ll be saying far more to patients.

The report is generated very quickly through a “quick text” or macro on our EMR. I type the word “NormalLipids” and the lipid result shows up with an interpretation. I type “NormalBMP” and “NormalCBC” for the others. When a lab or ward calls me with lab results on the phone, I don’t want to hear “it’s normal” but I also don’t want them to read off all of the numbers. A concise written report is best (IMO).

By: Margaret Polaneczky, MD

Margaret Polaneczky, MD — Sat, 22 Aug 2009 04:17:49 +0000

Interesting post,and even more interesting discussion in the comments section.

One thing to point out is that if 20 tests are done (and a metabolic profile or standard internist panel will get you that and more…), at least one will usually be out of range statistically, and meaningless clinically. I find that if I mail complete results to my patients, I end up getting phone calls from them later, worried that I had missed something. I tend to scribble little things like “okay” next to these abnormalities to assuage their fears, but it does not always work.

I think most of my patients would appreciate the bottom line report with an interpretation rather than a copy of the raw reports.

I am very curious how you generate your bottom line reports. They look like a lot of work to generate, making me wonder if a phone call would be faster. Do you have a document template you’d be willing to share?

Thanks again for a very thoughtful post.

By: David Lubin, MD

David Lubin, MD — Fri, 14 Aug 2009 23:48:14 +0000

Hornets’ nest is right! Maybe the key is NOT to mail or email the results but to get the patient into the office to go over the results in person so that you can say, that “this is insignificant, or that doesn’t mean much.” They are more likely to understand if you tell them in person. I had to tell a patient, just today, that I had no idea what the radiologist meant when he said, “there was a hook on the acromion.” I could have guessed, but to try to explain it, nuh, uh.

By: Fluff Kills | Why Useless Information is Killing People

Fluff Kills | Why Useless Information is Killing People — Wed, 12 Aug 2009 02:30:42 +0000

[...] though it resulted in accusations of an insecure ego, I am glad that I kicked the hornets nest in my previous post. This discussion made me realize something that has been bothering for a long time. Now I know [...]

By: Lady patient

Lady patient — Wed, 12 Aug 2009 00:36:10 +0000

Yes, you can give me the bottom line, and that will suffice as far as I’m concerned. But I still want the unexpergated version for my personal records, and to bring along to a new doctor who I think would want to do his own interpretation of the results. I don’t know what the big deal is all about. You must have a lot of hysterical patients. Personally, I go directly to the lab to get a copy, so I don’t have to bother the doctor’s staff.

By: Hildy

Hildy — Tue, 11 Aug 2009 05:44:43 +0000

Don’t ignore RDW! There are suggestions that an elevated RDW is more sensitive for Fe deficiency than lowered MCV, and helps in distinguishing Fe-deficient anaemia from anaemia of chronic disease.

The test that I almost always completely ignore is Cl; I write out my serum chemistry as Na-K-U-Cr.

By: Anon

Anon — Tue, 11 Aug 2009 05:28:16 +0000

I used to have a PCP who mailed a copy of all the details, with a special 4×6 postit type form stuck to it. The postit had rows for the big stuff, columns for ok/high/low, and a nurse or MA filled in the numbers. The doc initialled it and jotted quick notes on the full detail sheet- stuff that explained not-really-abnormals. Very brief stuff like “noted, caused by this med/virus, not concerning for your age, recheck 3 months etc.

You’re going to have problems with people who overreact, but I really liked the postit system. It let me know stuff wasn’t missed.

I want the full report- I’m an RN, I can handle it. . But I wouldn’t expect you to keep straight which of your patients want it and which don’t.

By: Rob

Rob — Mon, 10 Aug 2009 23:12:51 +0000

I agree. That’s what the long-range plan is. I actually would rather send my interpretation and then just make the whole panel available. I do wish, however, that there wouldn’t be so many dumb things included on normal test panels.

By: Should Doctors Sanitize Lab Data For Patients? | Medical News

Should Doctors Sanitize Lab Data For Patients? | Medical News — Mon, 10 Aug 2009 22:59:58 +0000

[...] concerns about computer generated abnormal lab values that have no clinical significance. And he is getting ripped up by patients who say that full lab reports should be sent to patients. Dr Rob, I”m going to [...]