Erroneous laboratory results

Knapp, Lucy LKnapp at PEACEHEALTHLABS.ORG
Fri May 27 18:14:22 UTC 2016


As a medical technologist with close to 40 years’ experience I am so offended by this poorly educated comment I don’t even know how to respond. I do agree that history and physical are extremely important, but objective data and the ability to correctly use the data – both in ordering tests and interpreting results is just as important. Recent studies (sorry, I can’t quote a source, but I’m sure anyone with laboratory experience will agree) have shown as much as 70% of medical decisions are based on diagnostic testing and at the same time the cost of that testing is 3% of the total medical costs in the US.

Personal experience – History and physical diagnosed a painful uterine “fibroid’ in 2012. I had a hysterectomy using morcellation; no danger of cancer, obviously. Pathology testing of the removed tissue showed Leiomyosarcoma – unstageable because of the morcellation, but undoubtedly spread by morcellation. I’m currently trying to deal with recurrence. Additional pathology testing for estrogen receptors has provided me an additional “gun” in the fight.

Please – don’t dismiss what you don’t understand.

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: Jason Maude [mailto:jason.maude at ISABELHEALTHCARE.COM]
Sent: Friday, May 27, 2016 2:55 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Erroneous laboratory results


This message originated outside of PeaceHealth's email system and contains web links. Use caution when clicking on links. VERIFY THE SENDER before opening attachments, clicking links or providing information.
How is it the profession has ended up placing such reliance on an aspect which is shown to contribute so little and cost so much?

This study backs up the old adage that 80% of the diagnosis is given by the history and physical with relatively little contributed by tests
http://archinte.jamanetwork.com/article.aspx?articleid=1106285<https://mail2.peacehealth.org/enduser/classify_url.html?url=SRKJG9+bKBsCsym7kQNOcDkS6NcPUsik/R0n2BFbRkRPfGwyYd2lLfnMCg+upqON3/dK89OabI4jSAPKTwURVA==>

To paraphrase Churchill, never in an industry has so much been shown to contribute so little for so much expense!

Regards
Jason Maude


From: Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at GMAIL.COM>>
Date: Wednesday, 25 May 2016 17:08
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Erroneous laboratory results

I'm a "thin" lab tester and 90% of what I order I don't need.
My junior confreres order easily double my volume.
Same outcomes narrowly defined; fully defined, worse outcomes.
(I don't order d-dimer on patients without at least moderate likelihood PEs or DVT. My junior guys do so routinely and so do many more CTA and U/S. We have the same rate of final diagnoses. But I (likely) have fewer renal failures (we don't see followup) and fewer bankruptcies.

Take, for example, ABGs. They are rarely needed; the same data is available venously and from already done tests (BMP/MGA/SMA7), pulse ox and EtCO2, yet I see 40% of our ICU tests are ABG.
CBC with diff when most folks can't interpret the diff but don't know they can't. CBC without diff when you only need the Hgb.
EKG in my shop is an excellent predictor that you do NOT have ACS.
All LPs go to IR.

I could go on.
So overtesting is huge.

tom benzoni

On Wed, May 25, 2016 at 10:20 AM, Cameron Powell <cameron at physiciancognition.com<mailto:cameron at physiciancognition.com>> wrote:
Perhaps some of you have already seen this study on under- and over-testing.


“First we found that the rate of overuse, meaning [medical laboratory] tests that we performed that shouldn’t have been performed, average around 20%. That means out of every 10 tests ordered about two tests on average should not have been ordered.

“Even more surprising was the rate of underuse [of medical laboratory tests]. This is the rate of tests that should have been ordered in a given time but weren’t ordered. That rate was over 40%. So, for every three tests performed, an additional two tests should have been ordered.”

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962<https://mail2.peacehealth.org/enduser/classify_url.html?url=BxZ18kZyS6/KbPy/1ujgfTFrANiURXwk9lu0BcA37sQiueOJlTGHIQYgv3MPwM/VOughlTjYANbZQFZKLC1gNg1hOHMtXP+U9p3xGL+KxP0=>

We’ve taken a run at solving suboptimal testing strategies and it’s going very well. We’ll keep you posted on our progress.

Cameron



Teaching Mode is Here! (Android<https://mail2.peacehealth.org/enduser/classify_url.html?url=imGsfm3ZNesqbP1TCmWOGASQo7k4WxSSgHzcyCv3fKrrXbqRp0dPI35H4ZTlUWueZrBN45CXLydjYw7283X2CXPd451/aS/cjQxRlQ1TzAs=> | IOS<https://itunes.apple.com/us/app/xebra-pro/id1051676634>),


Cameron Powell  |  CEO, Physician Cognition, Inc.
  ———————————————————————
  •:  503 502 5030<tel:503%20502%205030>
  •:  Cameron at PhysicianCognition.com<mailto:Cameron at physiciancognition.com>
  •:   PhysicianCognition.com<https://mail2.peacehealth.org/enduser/classify_url.html?url=tm0RsqSiffd2djt32oSygEjmXlBSS9AH1yTF0M6A4is=>
 Watch Xebra Pro in action!<https://mail2.peacehealth.org/enduser/classify_url.html?url=dkoKAD9Dgsrkfu6keZWIk2rCFSQC15Sv3/wq3KfpsLU=>
  Follow On:
  Twitter - Company<https://mail2.peacehealth.org/enduser/classify_url.html?url=kaTpWu4oiE4MJvNQ9aqcAEQi7FOH/yGbbn5qfkCY2R5exBWDlCHrDCqGevrkBshi>
  Twitter - Personal<https://mail2.peacehealth.org/enduser/classify_url.html?url=uvw+mZhHWusDE4LfQvtkOd3b9LocPFu6zxp3JF3fTH9lQ2o+CM0KywgCvsQYUXKp>
Facebook<https://mail2.peacehealth.org/enduser/classify_url.html?url=vmBBWiRNuECUEBbh+B17RjJrqCv2EHDKfhkzqiCT0gfZkb1/EDZqkVRTMN1UcfONeCwyIazKrsE6og1ttgT+6g==>

[cid:image001.png at 01D1B807.EAD710E0]

On May 20, 2016, at 12:40 PM, DR WILLIAM CORCORAN <williamcorcoran at SBCGLOBAL.NET<mailto:williamcorcoran at sbcglobal.net>> wrote:

What do you think of the YouTube video and the comments posted?

WSJ journalist John Carreyrou shares year-long Theranos investigation & breaks latest, stunning news<https://mail2.peacehealth.org/enduser/classify_url.html?url=PXYTP0DfAoGKNy2qWUaxDadPXd0hfftNChM33MkbHcI=>




[image]<https://mail2.peacehealth.org/enduser/classify_url.html?url=PXYTP0DfAoGKNy2qWUaxDadPXd0hfftNChM33MkbHcI=>











WSJ journalist John Carreyrou shares year-long Theranos ...<https://mail2.peacehealth.org/enduser/classify_url.html?url=PXYTP0DfAoGKNy2qWUaxDadPXd0hfftNChM33MkbHcI=>


View on youtu.be<https://mail2.peacehealth.org/enduser/classify_url.html?url=PXYTP0DfAoGKNy2qWUaxDadPXd0hfftNChM33MkbHcI=>

Preview by Yahoo







Take care,

Bill Corcoran


William  R. Corcoran, Ph.D., P.E.
21 Broadleaf Circle
Windsor, CT 06095-1634
860-285-8779<tel:860-285-8779>
William.R.Corcoran at 1959.USNA.com<mailto:William.R.Corcoran at 1959.usna.com>
http://www.linkedin.com/in/williamcorcoranphdpe<https://mail2.peacehealth.org/enduser/classify_url.html?url=grUuPh2Y1yp5jXJzQmUTYus/AVT/0rp7IZvdELgtXB4A4KGm7s1jjip5XmzH7/aM>
https://www.box.com/shared/kfxg1lt9dh<https://mail2.peacehealth.org/enduser/classify_url.html?url=eyYEaShs9B/PkcYiyojPU/yR/XxJlJP0hwHBPJK0K0oNzuk4e6kW5e4oJx26XJW4>

On Friday, May 20, 2016 11:10 AM, Dwight Oxley <dwight.oxley at GMAIL.COM<mailto:dwight.oxley at gmail.com>> wrote:

The link below details how a large number of erroneous results were reported from a commercial medical laboratory. This report is just the latest in the Wall Street Journal’s coverage of the Theranos Co. Lab results account for more than 50% of the information in a medical record, thus the impact of these is enormous.

Dwight Oxley


http://on.wsj.com/1TpKiL3<https://mail2.peacehealth.org/enduser/classify_url.html?url=iTdf6NEttgW/V5B52qqWhkdYtwG9sKVjV9kGwBzHuhU=>

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOutgugZP9kVnYEPuFAsUQb2hGFFy1pfDsM0NC2QgqrOBW21mWOjE9KzlaNVUmAWkMKQ> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at list.improvediagnosis.org>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOut1oRyX1aojj961DlpykqPpQ==>
Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/<https://mail2.peacehealth.org/enduser/classify_url.html?url=UrssAVhvAA8+5X8SGb6C6Q3NYgMkGqkpG69iRlENxV70c1bGrHTHokhXvG7YFN7l>


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOutgugZP9kVnYEPuFAsUQb2hGFFy1pfDsM0NC2QgqrOBW21mWOjE9KzlaNVUmAWkMKQ>

or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at list.improvediagnosis.org>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOut1oRyX1aojj961DlpykqPpQ==>


Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/<https://mail2.peacehealth.org/enduser/classify_url.html?url=UrssAVhvAA8+5X8SGb6C6Q3NYgMkGqkpG69iRlENxV70c1bGrHTHokhXvG7YFN7l>



________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOutgugZP9kVnYEPuFAsUQb2hGFFy1pfDsM0NC2QgqrOBW21mWOjE9KzlaNVUmAWkMKQ> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOut1oRyX1aojj961DlpykqPpQ==>
Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/<https://mail2.peacehealth.org/enduser/classify_url.html?url=UrssAVhvAA8+5X8SGb6C6Q3NYgMkGqkpG69iRlENxV70c1bGrHTHokhXvG7YFN7l>


________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOutgugZP9kVnYEPuFAsUQb2hGFFy1pfDsM0NC2QgqrOBW21mWOjE9KzlaNVUmAWkMKQ>
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOut1oRyX1aojj961DlpykqPpQ==>

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/<https://mail2.peacehealth.org/enduser/classify_url.html?url=UrssAVhvAA8+5X8SGb6C6Q3NYgMkGqkpG69iRlENxV70c1bGrHTHokhXvG7YFN7l>

________________________________

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>

To unsubscribe from IMPROVEDX: click the following link:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1<https://mail2.peacehealth.org/enduser/classify_url.html?url=P4JeiEdQ8JXS0jGbSQNeoCNP5x6BIz6Aj0TpSUpjJFwveji9BsZVeZFgSweiLOutgugZP9kVnYEPuFAsUQb2hEZA9boc5hH3cvuDGw+3Y8w=>
or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>

Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

Moderator:David Meyers, Board Member, Society for Improving Diagnosis in Medicine

To learn more about SIDM visit:
http://www.improvediagnosis.org/

This message is intended solely for the use of the individual and entity to whom it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable state and federal laws.  If you are not the addressee, or are not authorized to receive for the intended addressee, you are hereby notified that you may not use, copy, distribute, or disclose to anyone this message or the information contained herein.  If you have received this message in error, immediately advise the sender by reply email and destroy this message.

To unsubscribe from the IMPROVEDX:
mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG

For additional information and subscription commands, visit:
http://www.lsoft.com/resources/faq.asp#4A

http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)

Visit the searchable archives or adjust your subscription at:
http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX

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

To unsubscribe from the IMPROVEDX list, click the following link:<br>
<a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

HTML Version:
URL: <../attachments/20160527/0c776f3d/attachment.html> ATTACHMENT:
Name: image001.png Type: image/png Size: 3718 bytes Desc: image001.png URL: <../attachments/20160527/0c776f3d/attachment.png>


More information about the Test mailing list