A Night in the Lab

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         It's another night at the job when I received a phone call from the floor in regards to a test. For the record, I work in the microbiology department in the hospital lab. The conversation would often go something like this:

"Hi, I'm <insert clinician's title here>, and I have a question about a patient test."

         To which, I would reply:

"Hit me up with me the patient accession number and I can look it up for ya."

         More often than not, the result entry would either be "in progress" or nothing. I would relay that and the a follow up response would ensue.

"I have ordered this <some hours before, sometimes "stat"> and need the results."

         By this point, I would repeat what to expect and let them know that we cannot fulfill their request. This is also followed up by a brief explanation of the workflow and how long the test would take.

         Sometimes, a less than satisfied response would come from the clinicians. For me and my coworkers, we chuckle after the phone call because of its comical nature.

Why is this significant?

         The above conversation involved medical professionals. It's not uncommon for one role not understanding the role of the other. In this case, the clinicians do not seem to understand that they have ordered a culture. A microbiology culture takes time.

         While molecular testing continue to advance, they can be expensive. One example at my lab is the use of the Verigene system. While convenient, our SOP reserves it for situations where results need to be out as soon as possible. Otherwise, we opt for cheaper, but lengthier methods that still offer quality patient care.

         The point being, clinicians, don't always understand what they are ordering. The other night, I had a call about a patient's AFB (acid fast bacillus) culture. The nurse practitioner ordered the test in the afternoon and wanted the results. I replied that the best I could do that night was the stain results. The practitioner was not amused knowing that the test could take up to 42 days. Alas, those are facts.

         The truth is, most clinicians do not have a laboratory understanding of microbiology. Unless you specialize in internal medicine or pathology, you wouldn't. It becomes frustrating when it becomes a point of conflict between the lab and the floor.

         Take a look at the curriculum for MDs at Havard Medical School:

http://www.medcatalog.harvard.edu/courselist.aspx?dep=&search=micro

         You have one required course there that's about a month long. The rest are electives. Unless those electives overlap with their specialty, I doubt students would take them. And I would agree that most of them do not need advanced knowledge in microbiology to be competent. The difference is that they don't seem to understand turn around time and some get mad over it.

         How about John Hopkins?

https://www.hopkinsmedicine.org/som/curriculum/genes_to_society/curriculum-overview.html

         The same thing could apply to nurses, physician's assistants, nurse practitioners, etc.

Thoughts

         There is a term called interdisciplinary collaboration in healthcare. this means different medical professional work together for better patient care. And trust me, that is impossible without the laboratory because we are the ones running tests. And through the tests, physicians et al are able to come to a diagnosis or choose the best treatment.

         When the scenario at the beginning of the post happens, it creates friction. Sometimes, it could also affect patient care. Imagine expecting results in a short time before treatment. Then, you realize that wasn't going to happen because you had no idea how long things would take to complete.

         I hope the clinicians have a cheat sheet that tells them the expected turn around time of each test. Another nice information would be how long the labs keep individual patient samples. That helps with add-on tests for the same sample. Patients generally do not enjoy giving out samples multiple times.

Some other tidbits

         One of the most annoying things clinicians do is labeling the source of the patient specimen as swab. That is incorrect. There is no part of the human body called SWAB. That is a transport medium. Doing so will result in the lab calling them as normal flora if they resemble as such. We need to know the site of collection to determine whether isolates are pathogens.

         Calling a urine sample urethral discharge may be correct from a technical standpoint. Either the clinicians are trying to sound smart or they aren't sure if they are looking for a UTI or STI.

         When we result something as betalactamase negative, that means you could use any beta-lactam antibiotics. Calling back and asking "where is the sensitivity data" would make us question your credentials.

         And that's a night in the life of working in a clinical laboratory.