Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, December 02, 2009

Requesting Blood Tests: The Right Way and the Wrong Way

Attention Partialists*; listen up!

Despite what you were taught in training, patients have more than just one organ. Yes, yes; I know your organ is of course the most interesting and important. Still, there is more to most patients than an eye, a heart, a pair of lungs or kidneys, or even a prostate.

Most of you have learned that there are times when findings in your organ implies that something may be wrong with one or more of the patient's other organs. Although your usual response is simply to shuffle the patient off to your buddy, the OtherOrgan specialist, there have been occasions out in the community when, your hands tied, you send them back to me instead. As a public service, I would like to take this opportunity to describe the right way to do this, as well as the wrong way.

Right way

Pick up the phone and say:
Dr. Dino, I saw this weird ditzeloma in the back of our mutual patient's eye. It can sometimes be associated with diabetes, so could you please take a look and see if that might be the case here?
Wrong way

Send me a fax on a safely prescription pad (which comes across the fax as almost completely black) saying:
Complete blood test to rule out metabolic diseases.
I'll give you a hint: "Rule out [a whole freaking class of conditions]" is not an appropriate way to format a request for either a blood test, or a consultation to evaluate for the condition about which you are concerned -- which is what this patient really needs.

Oh, and while we're at it, could you please refrain from recommending that my patient with no cardiac risk factors ought to be on a cholesterol medicine for a total cholesterol of 255, when I have already determined that her LDL is only 120, her triglycerides only 125, but her HDL is a whopping 110, and I have told her she is fine? Remember you're a surgeon; it's not like you're a doctor anymore. M'kay?





*A fabulous term from one of the AAFP ListServes referring to our colleagues who only take care of portions of patients.

10 Comments:

At Wed Dec 02, 08:11:00 PM, Blogger Polly said...

A general practitioner/family practitioner I know likes to call specialists "limited practitioners" :D

 
At Wed Dec 02, 09:31:00 PM, Anonymous Anonymous said...

And if you want labs, provide a diagnosis code. Do not expect me to read your mind/eat the lab charge because we don't have a workable diagnosis code.

 
At Wed Dec 02, 10:56:00 PM, Blogger Lazlo said...

"I know your organ is of course the most interesting and important"

Great line out of context.

 
At Thu Dec 03, 07:03:00 AM, Blogger Dragonfly said...

And when the two limited specialists confer, it is *occasionally* helpful if they send lab results and diagnoses back past the GP.
So they aren't sitting there trying to figure out what "my CA 125 had something going on with it" means for the patient sitting in front of them.

 
At Thu Dec 03, 07:09:00 PM, Blogger BladeDoc said...

A general surgeon is an internist that has completed his training.

 
At Thu Dec 03, 07:10:00 PM, Blogger BladeDoc said...

And then realized that general practice is painful, boring, and pays badly. :-)

 
At Fri Dec 04, 03:14:00 AM, Blogger Rogue Medic said...

It is always good to have a polite way (OK, not explicitly insulting, but polite is not in my bailiwick) of putting someone's arrogance in perspective.

 
At Fri Dec 04, 05:38:00 PM, Blogger StorytellERdoc said...

Hey

Great site and recent posts. Just found your site and I enjoyed it...well written. And I liked how you didn't just complain about the wrong way, you offered a solution!

And if that doesn't work, there's always another specialist in the same field.

And if that doesn't work, a dark alley may be necessary! LOL

Enjoy your weekend.

 
At Wed Dec 09, 06:26:00 AM, Anonymous Laparoscopic Surgery Abroad said...

Thanks for sharing the post its really informative.

 
At Thu Dec 24, 09:48:00 AM, Anonymous kcpke said...

Or what happens around here sometimes is that one partialist tells the patient to see another partialist and so on and so on, and they make a wide circle around me and I never find out what's going on.

 

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