Another argument for patient's access to their test results

Hoffer, Edward P.,M.D. EHOFFER at MGH.HARVARD.EDU
Tue Apr 22 13:59:35 UTC 2014


In many cases, a variety of slightly high or low values are of no significance.  Lab "normals" include the middle 90% or so of test results done on presumably healthy people - hence 5-10% of healthy people are arbitrarily defined as abnormal.  You have to look at the entire set.  For example, if one liver function test is slightly high but the rest are normal, odds are high that this is meaningless.  If all of the liver tests are slightly high, there is probably a liver problem. A CO2 of 32 (upper normal being 30) - IF other electrolytes are normal - is probably of no consequence.

Given the enormous number of tests frequently run, most healthy people will have one or two "abnormals" that are of no clinical meaning.


From: Vic Nicholls [nichollsvi2 at GMAIL.COM]
Sent: Tuesday, April 22, 2014 8:16 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Another argument for patient's access to their test results

I just got a "everything is NORMAL!" from one doc and there were several high and low values blatantly listed AND values that are *high/low for me*.

Yet doctors are the ones who tell us not to have the computer diagnose you. Obviously couldn't have been read by a human and if read by a doctor, this is scary ... I mean when 30 is the high for CO2 and your CO2 value is 32 ... you know?



As for that, *I* am the one who is explaining to doctors high albumin is caused by dehydration. Hypoalbumenemia causes metabolic alkalosis (why the CO2 is high, one of the things missed).

"Albumin is the major unmeasured anion and contributes almost the whole of the value of the anion gap. Every one gram decrease in albumin will decrease anion gap by 2.5 to 3 mmoles. A normally high anion gap acidosis in a patient with hypoalbuminaemia may appear as a normal anion gap acidosis. This is particularly relevant in Intensive Care patients where lower albumin levels are common. A lactic acidosis<http://www.anaesthesiamcq.com/AcidBaseBook/ab8_1.php> in a hypoalbuminaemic ICU patient will commonly be associated with a normal anion gap."

http://www.jcsm.info/documents/1302/Why_cachexia_kills_examining_the_causality_of_poor_outcomes_in_wasting_conditions.html
Thrombosis leading to expansion of unstable plaques leading to acute coronary syndrome and/or sudden cardiac death. Why my MPV & platelets are high.


I'm not suing these people, none of them have one shred of evidence that I have lawyers, but I do have the local medical schools' library use ... I'm trying to educate them. What does this say when a patient has had no TV in years and uses UpToDate, ClinicalKey, and medical journals, as the evidence to their doctor & they still miss it? I had one article from 2003 that proved an issue and the doctor said in my notes, I don't know about anything that can cause this from the surgery.

A lot of us just want medical care and people to learn from their mistakes. Rescue us before the damage is done. My priority is Team Patient. If I'm wrong I suffer for it. If the doctor is wrong, I've never seen them suffer for it.

Victoria



On 4/21/2014 8:45 PM, Therese Rey-Conde wrote:
I wonder if the group is reading too much into this dreadful mistake. Isn’t it possible it was a simple “typo” i.e. the technologist pushed the “reply all” button or something similar, in error?

We’ve all been caught in that trap that at least once.

Systems should be set up in organisations to prevent this from occurring.

Therese Rey-Conde MPH



Therese Rey-Conde
Queensland Audit of Surgical Mortality Project Manager
Northern Territory Audit of Surgical Mortality Project Manager





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From: Peggy Zuckerman [mailto:peggyzuckerman at GMAIL.COM]
Sent: Tuesday, 22 April 2014 2:18 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Another argument for patient's access to their test results

Quite similar to this is the very frequent situation in which a patient is told re the blood labs, "We'll call if there is a problem; otherwise, don't expect to hear from us".  Stats indicate that some 15-18% of labs with abnormalities are not reported to patients.  With the millions of tests done, that percentage reveals a tremendous weakness in our system, and another reason to be pro-active in getting and reviewing one's own labs.
Moreover, that statistic does not indicate whether the reported problems suggested by the abnormal labs ever trigger the proper follow up, not to mention are used efficiently in the diagnosis.  Case in point:  a PSA test is higher than normal, and patient is told to see specialist.  Is there a formal referral, are the abnormal labs provided to the new specialist, are new labs prescibed, does the GP inform expect and prepare for a response from the specialist?  No stats on any of that, which are certainly "delayed diagnosis" incidents.
If these labs and the value of them were EXPLAINED to patients, so that they understood the importance of the abnormal reading, more appropriate follow up by both patient and doctor would happen.



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