Sunday, May 24, 2009

Something to Remember...

Sometimes, in my line of work as a low-level hospital worker, I learn things that disappoint or shock. The latest discovery is related to time-dependent blood tests. I would say that at least 75% of the people who work in the laboratory drawing blood do not have education beyond high school and vocational training - those who do have more education are usually working toward getting into a nursing program. For those who stay in the lab, sometimes the vocational training is not thorough enough and common sense just does not exist. The following case demonstrates how important it is for all people in the medical field to have a basic understanding of medicine; they need to understand why they have to do the things a certain way and the consequences if they do not follow instructions.

Some phlebotomists, particularly on the graveyard and night shifts when it is not very busy, do not want to waste time going up to get multiple samples of blood from the same patient. This is understandable if the person is a hard stick and there will be no difference if the blood is drawn at that time, or at two different times. However, some tests are measuring a person's metabolism of certain medications, and are supposed to be drawn right on time, sometimes as often as every two hours. Vancomycin is one of the common antibiotics which requires blood tests to determine the trough and peak levels of the medication. Learning that some lab assistants draw all the tubes at the same time and then write fake times (as in, they draw a tube at midnight but write that they drew it at 2:00 am) is rather alarming. If I were a patient's doctor and I thought their trough and peak levels were lower than in actuality, I would have to increase their medication and possibly cause harmful side effects. The ramifications of giving doctors incorrect information can be fatal - hearing this almost makes me want to draw all of my future patients' blood samples myself! Alas, it is not feasible, but it will at least make me think twice when I get back unexpected drug level reports.


  1. Hi!

    I assume you're from the US, and it's shocking that this kind of unprofessionalism exists there, too.

    Nice to come across someone conscientious.

    Take care and all the best!

  2. Thanks for the comment, maybe I'll run into you in the US if you come here for residency or practice. At Kaiser, there are tons of doctors from India.

  3. Sins and ommissions can occur at both ends of the bloodtest protocol. When at age 67 my wife suddenly felt lousy with sore muscles and stiffness she went and saw her Kaiser doctor. She was told she was getting old and she would have to live with her symptoms of "old age." Her doc ran a blood test including sedimentation rate to look for inflammation, and said he would call if anything unusual was found. A week went by without a call and my wife could barely get out of bed and was in a lot of pain. Finally I called the doctor. He said the test took 10 days and he would call back. I checked and found it took a few hours so I called back and demanded the results. He found them in a stack of papers on his desk and from the high sedimentation rate diagnosed likely fibromyalga rheumatica. She has since recovered and is healthy and strong at age 73. Patients need advocates to protect them and insist on prompt and professional care.

  4. I'm sorry you had such an uncaring doctor at Kaiser - I know for a fact those tests take exactly one hour to run (they set it up and the blood flows up a slender tube, the level that it reaches determines the result), they time it. It is time doctors stopped treating pain as something that just "comes with age" because they don't feel like going through the trouble of understanding an elderly patient's unique situation.