Earlier this week I was meeting a new rheumatologist to possibly replace my doctor who has retired. Ahead of time I picked a few questions to help determine if we might be a good fit. But I was also quietly evaluating the office and its staff – from the logistics of parking, to the receptionist and nurses, and the efficiency of the visit overall.
After negotiating the confusing parking lot and navigating my way through the building to the office, it didn’t take long to get checked in. I was a few minutes early so I read email on my phone and worked a monster Sudoku puzzle. After about 20 minutes, I made eye contact with another patient and we started a brief conversation.
I asked her: How long does it normally take before you’re called back for your appointment? She gave me a sheepish look, so I encouraged her – no, honestly, how long does it take? She said that sometimes it’s “not too long” but that it was an hour for a recent appointment. She asked if I had been waiting long, which I had not, but I noticed that no one had been called back during the 20 minutes I had been waiting and the number of people in the waiting area was growing. (I ended up waiting 30 minutes.)
Not long after this discussion a woman came in and approached the registration desk. She wanted a copy of her lab results and to talk to “whomever it is that usually calls with test results.” The girl at the desk said that person could be any one of them, depending. The previous Friday, the woman had received a phone message regarding lab work and was confused about instructions given to change her medication. She had been trying to call the office all morning and couldn’t get through so she drove up to the office instead.
Based on the conversation, it became apparent that the woman wanted to understand a few basic things: what was abnormal about her lab results, what was the significance of specific tests, why was she being asked to change her meds, what was that supposed to do, and how would she know if the change successfully accomplished what the doctor wanted?
She was obviously concerned and somewhat confused. But rather than offer to let her talk to the nurse, the receptionist responded to her questions with superficial answers that didn’t explain much of anything. I wanted so much to be able to interpret for her what was being said. Her liver enzymes were elevated which is why her doctor wanted her to only take 2 methotrexate tablets that week instead of her usual dose. The patient also wanted to know about SED rate and a few other tests. Her questions had answers, but probably not ones which should have come from a receptionist.
Read this post in its entirety:
Evaluating the Doctor's Office: Who Do You Talk To About Laboratory Results?
Showing posts with label Blood Work. Show all posts
Showing posts with label Blood Work. Show all posts
Thursday, December 31, 2015
Wednesday, January 11, 2012
National Blood Donation Month
What did you do special for New Year’s? Do you have any special traditions? Or do you still need to make a New Year’s Resolution or two?
For years, my father and I had a routine we shared during the holidays when I would travel home from college. We would go downtown into Oklahoma City to the Oklahoma Blood Institute to donate blood. That became part of our New Year’s celebration.
Since 1970, January has been recognized as National Blood Donation Month in the United States. It is a time of year where blood is traditionally in short supply, partially due to the holidays, travel schedules, inclement weather and illness. No matter the time of year blood is always in need.
If you wish to donate, call your local blood bank. Be prepared to reveal your diagnoses and provide a list of the medications you use. If you are not able to give your own blood, you can still contribute by spreading awareness and encouraging others to donate, or by providing a financial donation.
Read this post in its entirety:
Give a Pint. Save a Life. Become a Blood Donor.
For years, my father and I had a routine we shared during the holidays when I would travel home from college. We would go downtown into Oklahoma City to the Oklahoma Blood Institute to donate blood. That became part of our New Year’s celebration.
Since 1970, January has been recognized as National Blood Donation Month in the United States. It is a time of year where blood is traditionally in short supply, partially due to the holidays, travel schedules, inclement weather and illness. No matter the time of year blood is always in need.
If you wish to donate, call your local blood bank. Be prepared to reveal your diagnoses and provide a list of the medications you use. If you are not able to give your own blood, you can still contribute by spreading awareness and encouraging others to donate, or by providing a financial donation.
Read this post in its entirety:
Give a Pint. Save a Life. Become a Blood Donor.
Monday, October 24, 2011
Hand-Written Orders Required
As an empowered patient, I keep track of all tests and results. I recommend to others that they do the same. If you get blood tests done, request copies. If you have an MRI, get copies of the radiologist's report and a computer disc of all pictures. These are just the beginning of taking care of your health. The next step is understanding what is found in these test results.
In my area, getting copies of MRI results is super easy. The MRI technician asks you to wait a moment when the tests are done. You wait for 5 minutes or so and a CD is brought to you with the images taken during the test and the software needed to view the images. You are expected to keep this CD for your records and to take it with you to your next neurologist visit. In a couple of days, you can walk up to the front desk of the same MRI center and request a copy of the radiologist report. (You probably can probably call to get a copy mailed to you, but this is faster in my case.)
Ever since I started on this journey of living with chronic illness, I've learned the importance of tracking something as simple as your blood test results. It was from copies of previous blood tests dating back to the very beginning of early RA symptoms in my hands (when things were still very vague and I knew that 'something just isn't right') that my rheumatologist informed me that my undiagnosed RA had dated back a few years. My primary doctor didn't recognize the very subtle pattern found in those blood tests.
When I get first diagnosed with MS, it was easy to get copies of blood tests. All I had to do was ask that a copy be sent to me when I was at the local lab for the blood draw. I would always get a copy in about a week.
A couple of years ago was the first time that the technician at the local Quest lab would not add my to the list of recipients for the tests. She eventually did call my rheumy's office which was in the same building to ask if she (my doctor) gave permission for me (the patient) to get copies of the tests. Something had changed in the state of Virginia. Patients no longer could have easy access to records.
So since that one trip to the lab, I made sure to ask my rheumatologist to add me on the courtesy copy list which always includes my neurologist and primary care doctor. Sharing test results between doctors helps to cut down on the number of blood draws I undergo during the year and it keeps everybody in the loop.
Requesting this addition to the standing order I get twice a year for routine blood work takes an extra moment during the appointment and takes a tiny bit of my attention away from other things which might be important to discuss. But that is one cost of staying empowered.
A few weeks ago, I had a neurology appointment. It was time for routine blood tests and my standing order had expired. So my nurse practitioner wrote an order which would cover her interests and those of my rheumy. She listed those other doctors as recipients of the results. She also indicated on the order that I (the patient) should also receive a copy.
The neurology clinic is so forward thinking that they had added a statement and box which could be marked to indicate that records be sent to the patient. My nurse practitioner not only put an X in the box, she circled the entire statement so that it would not be missed at the lab when the order was actually processed.
That same week I met with a new doctor, a cardiologist. This doctor had a couple of other tests which she would like to have. So she added her additional requests to the order and added her name to the list of recipients. This was not a problem, but now there are four doctors to receive the results in addition to me, the patient.
My follow-up appointment with the cardiologist is Wednesday. I have been having irregular heartbeats and wore a Holter monitor for a day to record my heart activity. The answer to the irregular heartbeats could be something as simple as a magnesium deficiency. I would know if this were likely, IF I had received my test results.
But...I will be going into this appointment without knowing the test results. Quest did not send me a copy. I am not happy about that.
I called Quest to find out if there had been a problem processing my results. What I found out really makes me angry. Apparently as the technician was adding doctors to receive results (and she had already added me first as I insisted), I (the patient) was bumped off the list. There is only room on the request form for three additional recipients for the records.
Only room for three. That was the first problem. The next problem is that I was told in the state of Virginia that the request for copies to the patient must be hand-written on the order. Pre-typed statements on the order form are not accepted. That is ridiculous in my book. If my doctor wants to make it easier for the patient to be empowered and save time during the office visit when filling out orders, why can't it be accepted?
At the risk of sounding calm about it, I was not a happy camper when I was told this tidbit of information. My neuro's order forms are geared toward efficiency and effectiveness of use. My rheumy's order forms are not equally up-to-date with the latest philosophy in participatory medicine.
But the rheumatologist's orders are accepted when she cc's the patient. My neurologist's orders are not accepted. There is something wrong with this picture. It's like a step backward and "regulations" are putting up unnecessary barriers to information.
So what's the solution? For me, I will have to ask the cardiologist's office to print me a copy of the blood test results. I don't think that it should be a problem (I hope) especially since as my first appointment, I brought my spreadsheet of all my blood test results dating back to 2003.
I keep this spreadsheet updated in my computer every 2-3 three months. I can see trends which correlate to different changes in health, both temporary and permanent. I can see that Tamiflu caused my liver enzymes to shoot up through the roof but that methotrexate does not. I can see how different lymphocytes are affected during an MS exacerbation. Basically I can spot when things start to look unusual.
But according to the state of Virginia, I should not have access to my records unless: 1) my doctor gives permission, and 2) my doctor HAND WRITES the permission on the lab order.
HAND WRITES the request. How silly is that?
In my area, getting copies of MRI results is super easy. The MRI technician asks you to wait a moment when the tests are done. You wait for 5 minutes or so and a CD is brought to you with the images taken during the test and the software needed to view the images. You are expected to keep this CD for your records and to take it with you to your next neurologist visit. In a couple of days, you can walk up to the front desk of the same MRI center and request a copy of the radiologist report. (You probably can probably call to get a copy mailed to you, but this is faster in my case.)
Ever since I started on this journey of living with chronic illness, I've learned the importance of tracking something as simple as your blood test results. It was from copies of previous blood tests dating back to the very beginning of early RA symptoms in my hands (when things were still very vague and I knew that 'something just isn't right') that my rheumatologist informed me that my undiagnosed RA had dated back a few years. My primary doctor didn't recognize the very subtle pattern found in those blood tests.
When I get first diagnosed with MS, it was easy to get copies of blood tests. All I had to do was ask that a copy be sent to me when I was at the local lab for the blood draw. I would always get a copy in about a week.
A couple of years ago was the first time that the technician at the local Quest lab would not add my to the list of recipients for the tests. She eventually did call my rheumy's office which was in the same building to ask if she (my doctor) gave permission for me (the patient) to get copies of the tests. Something had changed in the state of Virginia. Patients no longer could have easy access to records.
So since that one trip to the lab, I made sure to ask my rheumatologist to add me on the courtesy copy list which always includes my neurologist and primary care doctor. Sharing test results between doctors helps to cut down on the number of blood draws I undergo during the year and it keeps everybody in the loop.
Requesting this addition to the standing order I get twice a year for routine blood work takes an extra moment during the appointment and takes a tiny bit of my attention away from other things which might be important to discuss. But that is one cost of staying empowered.
A few weeks ago, I had a neurology appointment. It was time for routine blood tests and my standing order had expired. So my nurse practitioner wrote an order which would cover her interests and those of my rheumy. She listed those other doctors as recipients of the results. She also indicated on the order that I (the patient) should also receive a copy.
The neurology clinic is so forward thinking that they had added a statement and box which could be marked to indicate that records be sent to the patient. My nurse practitioner not only put an X in the box, she circled the entire statement so that it would not be missed at the lab when the order was actually processed.
That same week I met with a new doctor, a cardiologist. This doctor had a couple of other tests which she would like to have. So she added her additional requests to the order and added her name to the list of recipients. This was not a problem, but now there are four doctors to receive the results in addition to me, the patient.
My follow-up appointment with the cardiologist is Wednesday. I have been having irregular heartbeats and wore a Holter monitor for a day to record my heart activity. The answer to the irregular heartbeats could be something as simple as a magnesium deficiency. I would know if this were likely, IF I had received my test results.
But...I will be going into this appointment without knowing the test results. Quest did not send me a copy. I am not happy about that.
I called Quest to find out if there had been a problem processing my results. What I found out really makes me angry. Apparently as the technician was adding doctors to receive results (and she had already added me first as I insisted), I (the patient) was bumped off the list. There is only room on the request form for three additional recipients for the records.
Only room for three. That was the first problem. The next problem is that I was told in the state of Virginia that the request for copies to the patient must be hand-written on the order. Pre-typed statements on the order form are not accepted. That is ridiculous in my book. If my doctor wants to make it easier for the patient to be empowered and save time during the office visit when filling out orders, why can't it be accepted?
At the risk of sounding calm about it, I was not a happy camper when I was told this tidbit of information. My neuro's order forms are geared toward efficiency and effectiveness of use. My rheumy's order forms are not equally up-to-date with the latest philosophy in participatory medicine.
But the rheumatologist's orders are accepted when she cc's the patient. My neurologist's orders are not accepted. There is something wrong with this picture. It's like a step backward and "regulations" are putting up unnecessary barriers to information.
So what's the solution? For me, I will have to ask the cardiologist's office to print me a copy of the blood test results. I don't think that it should be a problem (I hope) especially since as my first appointment, I brought my spreadsheet of all my blood test results dating back to 2003.
I keep this spreadsheet updated in my computer every 2-3 three months. I can see trends which correlate to different changes in health, both temporary and permanent. I can see that Tamiflu caused my liver enzymes to shoot up through the roof but that methotrexate does not. I can see how different lymphocytes are affected during an MS exacerbation. Basically I can spot when things start to look unusual.
But according to the state of Virginia, I should not have access to my records unless: 1) my doctor gives permission, and 2) my doctor HAND WRITES the permission on the lab order.
HAND WRITES the request. How silly is that?
Saturday, April 5, 2008
Visiting the Vampires - Praying for Blood
For those who sent well wishes yesterday, I really appreciate your concern and support. I am feeling better today and my Sweetie and I even went out for lunch and ate some fabulous Indian food. Yum.
Yesterday afternoon, however, is a different story. I went to the Quest lab to have blood drawn for routine tests. Since I take a chemotherapy drug for rheumatoid arthritis, we have to make sure that my liver is happy.
I went to my favorite lab only to find that the ineffectual vampiress was on duty. Darn. (Note: I had formed a wonderful relationship with the previous phlembotomist who ALWAYS performed a successful stick on the first try.) Well, last month time I let this woman try three times, unsuccessfully, before choosing to wait for her colleague to return from break to stick me twice more.
Usually when the phlembotomist (tech) starts looking at my hands for veins, that's when I say, "whoa, not the hands, they NEVER work!!" It doesn't matter that I point directly to the one really good vein I have which runs alongside a tendon deep in the center of my elbow. Of course, there are a few other spots which have been known to produce blood in quantities enough to fill a couple of tubes but they're not nearly as reliable. The one thing I absolutely hate is a cocky tech who "blows through" a vein and produces one lonely drop of blood in the needle. This type of tech would also be the one to go on a fishing expedition in search of elusive blood from a tiny vein which probably just collapsed in fear or dred.
Surprise - this is exactly what vampiress proceeded to do.
So rather than let her conduct an endless number of sticks, I asked to take my orders to a different lab as she was the only one on duty. I quickly hightailed it to another lab in a nearby medical building. OH NOOO... They were just about to lock the doors, so I begged and begged. Very pathetic I know, but I have to time the blood draws carefully to get really good readings. Either that or delay taking my weekly dose on the designated day, and after yesterday's discussion I think we can agree that it's important to stay on a regular schedule with meds.
I presented the first tech (yes there was more than one) with my good arm and pointed to the best spot. She was not convinced that it was a good vein, checked elsewhere, and tried a different one. And do you think that there was blood? Noooo. So then she wanted the other arm and I dutifully presented it to her. She thought maybe there was a vein, thought maybe not. Another tech came over, checked herself, and pointed to yet a different spot.
Another stick - another bloodless failure.
She started looking at the hands and I said, "Um no, not the hands." Tech number two didn't volunteer as she had already pointed out her top location for a stick. So tech number three was summoned and he looked first at the hands. And what do you think I said? He even contemplated my wrist...again uh-uh. "My best vein is right here, down deep, running right next to the tendon, really, trust me it's there." He takes a quick look at my left arm which had already been pincushioned sufficiently. And I repeat, "the best vein is here and the next to best vein is here," pointing to the appropriate spots.
Surprisingly, these two spots remained virginly unstuck even after going through three techs already. This guy tightened the tourniquet and waited for the blood to plump up the veins while I squeezed on a soft ball. He took a leap of faith and went deep. Hallelujah - Success!! The other two techs watched closely and were amazed that blood flowed quickly enough to fill the appropriate lavender and red lidded tubes. The tech suggested to me that next time I should point out my good vein (just as I had to him and three other ladies yesterday) and suggest tying the tourniquet really tight...oh...and to mention that the vein is really deep and runs next to the tendon.
If only people would listen to me, especially when I'm being very pleasant, upbeat, and trying to stay as relaxed and non-fainty as possible. I'm sure that my arms would appreciate it.
Yesterday afternoon, however, is a different story. I went to the Quest lab to have blood drawn for routine tests. Since I take a chemotherapy drug for rheumatoid arthritis, we have to make sure that my liver is happy.
I went to my favorite lab only to find that the ineffectual vampiress was on duty. Darn. (Note: I had formed a wonderful relationship with the previous phlembotomist who ALWAYS performed a successful stick on the first try.) Well, last month time I let this woman try three times, unsuccessfully, before choosing to wait for her colleague to return from break to stick me twice more.
Usually when the phlembotomist (tech) starts looking at my hands for veins, that's when I say, "whoa, not the hands, they NEVER work!!" It doesn't matter that I point directly to the one really good vein I have which runs alongside a tendon deep in the center of my elbow. Of course, there are a few other spots which have been known to produce blood in quantities enough to fill a couple of tubes but they're not nearly as reliable. The one thing I absolutely hate is a cocky tech who "blows through" a vein and produces one lonely drop of blood in the needle. This type of tech would also be the one to go on a fishing expedition in search of elusive blood from a tiny vein which probably just collapsed in fear or dred.
Surprise - this is exactly what vampiress proceeded to do.
So rather than let her conduct an endless number of sticks, I asked to take my orders to a different lab as she was the only one on duty. I quickly hightailed it to another lab in a nearby medical building. OH NOOO... They were just about to lock the doors, so I begged and begged. Very pathetic I know, but I have to time the blood draws carefully to get really good readings. Either that or delay taking my weekly dose on the designated day, and after yesterday's discussion I think we can agree that it's important to stay on a regular schedule with meds.
I presented the first tech (yes there was more than one) with my good arm and pointed to the best spot. She was not convinced that it was a good vein, checked elsewhere, and tried a different one. And do you think that there was blood? Noooo. So then she wanted the other arm and I dutifully presented it to her. She thought maybe there was a vein, thought maybe not. Another tech came over, checked herself, and pointed to yet a different spot.
Another stick - another bloodless failure.
She started looking at the hands and I said, "Um no, not the hands." Tech number two didn't volunteer as she had already pointed out her top location for a stick. So tech number three was summoned and he looked first at the hands. And what do you think I said? He even contemplated my wrist...again uh-uh. "My best vein is right here, down deep, running right next to the tendon, really, trust me it's there." He takes a quick look at my left arm which had already been pincushioned sufficiently. And I repeat, "the best vein is here and the next to best vein is here," pointing to the appropriate spots.
Surprisingly, these two spots remained virginly unstuck even after going through three techs already. This guy tightened the tourniquet and waited for the blood to plump up the veins while I squeezed on a soft ball. He took a leap of faith and went deep. Hallelujah - Success!! The other two techs watched closely and were amazed that blood flowed quickly enough to fill the appropriate lavender and red lidded tubes. The tech suggested to me that next time I should point out my good vein (just as I had to him and three other ladies yesterday) and suggest tying the tourniquet really tight...oh...and to mention that the vein is really deep and runs next to the tendon.
If only people would listen to me, especially when I'm being very pleasant, upbeat, and trying to stay as relaxed and non-fainty as possible. I'm sure that my arms would appreciate it.
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