[EXTERNAL] Re: [IMPROVEDX] Support Tests.

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Mon Jan 25 23:33:15 UTC 2016


Speaking on behalf of patients, I am always concerned that patients are the
last to know of results that might be of concern to their doctors.  (To
think that the measures re the prostate are not noted as being specific for
those with prostates is pretty shocking.  Having just one kidney, I monitor
my creatinine, but wonder how the one kidney vs two might be affected in
standard lab reporting.

It would be quite  easy to keep website page to teach patients about those
lab results, what the ranges are for their lab provider, and the simplest
of explanation as to what that lab is measuriing.  In an ideal world, the
doctor would have explained what he was most concerned about, and the
reason for the labs in the first place!  Since 15-30% of labs which are
problematic are not reported to the patient, and more frequently not given
to them in a meaningful way, i.e., with no normal ranges indicated, this
could go a long way to educating the patient, and making certain that the
results reach the patient. I would like to assume that the doctor reviews
all such labs, but knowing otherwise, this would be a second look.

When the patient must return to the doctor to receive the labs, only to be
told they are normal, and that no further follow up is needed, he may come
to distruct the doctor or feel that the financial incentives outweighed his
own needs.  And on the way home, the patient will hear on the radio that we
need more doctors or that patients cannot find physicians when they are
clearly in need.

Getting some basic education to as many patients as possible is certainly
part of sharing the burden of a diagnosis, and we should encourage it in
many forms.

Peggy Zuckerman

Peggy Zuckerman
www.peggyRCC.com

On Mon, Jan 25, 2016 at 2:08 PM, Dwight Oxley <oxley.dwight at gmail.com>
wrote:

> After thirty-five years as a hospital lab director, I can safely say that
> clinicians rarely share your view; they send the tests out to the cheapest
> vendor and there is usually no interpretation.
>
> On Jan 25, 2016, at 2:20 PM, Sherri Loeb <sherriloeb at GMAIL.COM> wrote:
>
> I understand it is the same, but interpretation is vitally important!
>
> On Mon, Jan 25, 2016 at 2:10 PM, Samuel, Rana <Rana.Samuel at va.gov> wrote:
>
>> The test *is* the same – just may be reported with a different reference
>> range or with an interpretive comment as in Lucy’s example below.
>>
>>
>>
>> *From:* Sherri Loeb [mailto:sherriloeb at GMAIL.COM]
>> *Sent:* Monday, January 25, 2016 2:41 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [EXTERNAL] Re: [IMPROVEDX] Support Tests.
>>
>>
>>
>> I find this comment particularly interesting considering my husband
>> passed away from metastatic prostate cancer. One he was diagnosed. We
>> noticed that occasionally his psa was ordered as psa screening to check
>> response to chemo and hormone therapy and other times as psa diagnostic. We
>> were told it is exactly the same. From reading this email, it is obviously
>> not the same.
>>
>>
>>
>> Thanks for the clear explanation.
>>
>>
>>
>> Sherri Loeb RN, BSN
>>
>>
>>
>> On Mon, Jan 25, 2016 at 1:01 PM, Knapp, Lucy <LKnapp at peacehealthlabs.org>
>> wrote:
>>
>> In a word – speaking for the laboratory world – Communicate those needs
>> to your laboratories. As an example, here we have two tests, “PSA,
>> Screening” which has a reference range up to 4 and “PSA, Diagnostic” which
>> also has a reference range of up to 4 but also includes an interpretative
>> comment: “According to the American Urological Association (AUA), serum
>> PSA should decrease and remain at undetectable levels after radical
>> prostatectomy. The AUA defines biochemical recurrence as an initial PSA
>> value of greater than or equal to 0.20 ng/mL followed by a subsequent
>> confirmatory PSA value of greater than or equal to 0.20 ng/mL.”
>>
>>
>>
>> In a prior life – we had 2 tests with different reference ranges, plus a
>> comment on the PSA, Diagnostic. Both options are easily done in an LIS (lab
>> information system).
>>
>>
>>
>> We in the laboratory would love to have better communication from
>> physicians – we want to make your lives easier. So my advice to all the
>> physicians out there is to build relationships with the pathologists and
>> laboratory personnel where you practice. Let us know where improvement is
>> needed to the LIS, you need a new test, you need better sensitivity on a
>> current test – whatever.
>>
>>
>>
>> I’m copying the to our medical director, we are trying to establish
>> better communication with our physicians throughout our system.
>>
>>
>>
>> Lucy
>>
>>
>>
>> *Lucy Knapp, MT(ASCP) *  |  Technical Specialist, Chemistry  |
>> Laboratory
>>
>> *PeaceHealth* <http://www.peacehealth.org/>  |  400 NE Mother Joseph
>> Place  |  Vancouver, WA 98664
>>
>> *office* 360-514-2732  |  *fax* 360-514-1646
>>
>>
>>
>> *From:* robert bell [mailto:
>> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
>> *Sent:* Sunday, January 24, 2016 1:56 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [IMPROVEDX] Support Tests.
>>
>>
>>
>> I have suggested that at the same time, or even before we tackle Errors
>> in Diagnosis, we see that all our support diagnostic tests (Lab, X-ray,
>> etc.) are in good order so as to help make the correct diagnoses more often.
>>
>>
>>
>> I have been made aware that it is easy to miss a low but rising PSA in
>> someone who has had a past radical prostatectomy.
>>
>>
>>
>> The Lab reports results as ng/mL with a reference range of (0.000 -
>> 4.000). The range for someone with a prostate present.
>>
>>
>>
>> I asked myself with all the technology is there anything that could be
>> done to prevent such happenings?
>>
>>
>>
>> And then I thought there must be 100s of similar situations when time,
>> disease, surgery, treatments, etc effect lab interpretations - the PSA lab
>> reports on the ones I have seen do not mention that the ranges are for
>> someone with a prostate. Should they?
>>
>>
>>
>> Yes, good clinical skills would help but could the lab with or without
>> technology do anything to help avoid such problems?  Could training or
>> anything else help prevent?
>>
>>
>>
>> I wondered how often this happens - and if you decided to do something
>> about it, could you triage it - presumably not without good error data!?
>>
>>
>>
>> Robert Bell
>>
>>
>>
>>
>>
>>
>>
>>
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>>
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>>
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>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
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>
>
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>
> To unsubscribe from IMPROVEDX: click the following link:
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
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>
> To unsubscribe from IMPROVEDX: click the following link:
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>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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