Blundering in your Healthcare

Health Alert 76

Clinical laboratories make mistakes. The mistakes often go unnoticed. These erroneous results can be dangerous. Today, you’ll find out how to protect yourself.

But first … a little insight into what’s happening at your lab. Then … I’ll give you tips to catch these lab errors … before they cause you harm.

Before medical school, I was a medical technologist. That’s a glorified lab tech with a 4-year BS degree and a year’s internship. After 2 years experience running a small rural lab I landed my dream job at a big-city hospital. My job was to assure the quality of laboratory results. It’s a job that, as director of the HealthCheck’s Program for the state of Florida, I still struggle with over 20 years later.

* How Did that Number Get on your Lab Report? *

Here’s an example of one disturbing lab slip-up from a few months ago. A 50-ish college administrator came to me suffering from menopausal symptoms. The first thing I do in a case like is an entire hormone work-up.

My nurse drew the patient’s blood and sent it to the lab. The lab results looked normal for a woman in her 50’s, except for one surprising reading. The lab reported that her testosterone level was 900! Only very young, virile men have testosterone levels of 900.

We retested her blood. Now, this patient’s testosterone level was 70! This error is easy to catch but it illustrates an important point. It is an example of the most common lab error.

Most errors occur not in the actual chemistry. The methodologies for the measurements are tightly quality controlled with good accuracy and reliability. By far, the most common form of lab mistakes is “transcription errors”. This means that a lab worker simply transfers the information incorrectly. The result for a test is placed in the wrong spot or someone else’s result is placed in the spot for your result.

* Combating Lab Blunders*

Here are some rules for catching lab errors as we did. Question results that seem strange. If your results appear unusual, immediately question them. Here are a few instances when you need to discuss retesting with your doctor:

• One test is “out of line” with others performed at the same time. Most of the time, your doctor will order several tests at once. If one of those tests is glaringly odd, you need to look into it.

• Your doctor makes medical decisions because of the test. Do not have surgery or other dangerous treatments based on a single test result. Always ask for a repeat analysis before other action is taken.

• Results have changed dramatically from last time you had the test performed. Dramatic differences in results from previous tests could be a sign of lab error.

Ask your doctor to perform additional tests to verify the results at the same time you repeat questionable results. Your doctor should not mind retesting. In fact, I would be weary of any doctor who gives you a hard time about retesting an unusual, abnormal or dramatically changed result.

And… here’s one more tip. There is a common lab test called a CBC. This is an abbreviation for Complete Blood Count. It is a panel of about 25 measurements of the cells in your blood. The last have of this panel is a detailed analysis of the size, shape, density and variability of your red blood cells. These parameters are very specific to you and don’t change much. When taken together they can serve as a “fingerprint” of your blood. It only costs about 20 dollars. If your doctor runs this test with your yearly blood screen, at least you can be sure that the lab specimen with your name on it is really your blood.

Al Sears MD