"…He asked for samples of my blood, and my urine, and my saliva, and my stool, and I said, ‘Sure Doc, but then… can we do what I like?’ " - Harvey Fierstein, “Pouf Positive”
Holy crap!
Seriously, it’s drilled into us that if the test result can’t wait until morning before you decide how to treat your patient, there is something seriously wrong.
I hope the 2am RSV was a joke. Unless RSV doesn’t mean respiratory Syncitial Virus in your lab.
I’m thinking most of these tests were for someone who overdosed on Aspirin. In which case, YES they’ve got a respiratory alkalosis, but they’re trying to compensate for the metabolic acidosis. Your doc sounds very dumb.
Partially digested fat does have a rather striking aroma, yes. 
Especially when the collection container explodes.
See, then it’s your fault for not pointing each result out to them specfically. On every patient. For every test result. Heck, there can’t be more than 5 or 6 hundred a day, can there? Piece of cake.
Well I work in a very busy ER and I order STAT tests all night long. What’s wrong with ordering tests on patients during the night? Granted we don’t have to call anyone in to run labs or ultrasounds or CT scans but was this doctor ordering these tests on patients that were already in the hospital? were these patients that came in the door undifferentiated and he was trying to make the diagnosis? I can think of reasons to order every one of those tests in the middle of the night.
11pm CBC - does this patient need a transfusion?
q2h Salicylates - is the activated charcoal effectively stopping absorption in the overdose patient or not?
1am electrolytes - this patient has funny looking T waves on EKG, better make sure they’re K isn’t elevated
5am cardiac panel - chest pain with cardiac history
6am INR - pt on coumadin with a bleed, do I need to reverse the coumadin?
Now if they were all on the same patient that had been there for hours or days…then I join in the pitting of Dr. Moronic Riviera.
Maybe I’m basing this on prejudices common to those of us in the lower provinces, but I’m not sure how busy an ER can get in Nunavut.
You’re talking about medically necessary testing. I have no problem coming in for that kind of stuff. The hospital I work at is definitely not a busy ER. It’s in a small town of about 6,000 people. All of these patients were walkins.
The CBC was on a 2 year old. On the req it had written down in the ‘diagnosis’ slot ‘? Fe def’. Stat how?
the salicylates - this chick was running 0.2 - 0.4 all day then peaked at 1.1 in the afternoon. (therapeutic range - 0.10 - 1.10 mmol/L). I fail to see ‘STAT’ in that - could they not wait and see the level in the morning? (they didn’t even charcoal her)
the lytes was on an infant - I don’t know why.
Cardiac panel was on a 40 something woman with a normal EKG trace, and so was the INR (right when I finished the TNI, then he added the INR which I had to go and draw).
Also, the RSV thing was not a joke. They have limited room upstairs in the ward and want to find out the RSV status of any child they admit so they can group the positives together. So now it’s a stat test.
You’re still right, I don’t know enough about doctoring to be second guessing what the docs are ordering…but I still know enough to see patterns when certain docs working, which docs the nurses think are insane and that questions about the respiratory alkalalinity of your patient should not be directed at your lab tech.
Anyways, it’s all moot now, he’s gone back to his family practice in Toronto.
Nunavut Boy I’ve worked with Doc Dumbass as well. He’s even worse in the ICU.
DD is a cookbook doc. He can’t make a decision without looking it up. Worse yet, he has to speak every thought that passes through his head so no one ever knows what he’s planning or what course of action he’s rejected. Hearing his flight of ideas is frightening, since most of his thoughts are wrong.
Half the time he’s ordering labs that he just ordered 2 minutes ago, before the previous blood has even reached the lab.
I feel your pain.
picunurse, (and all others who have read my plight), thank you for the sympathy. I am SO glad that nothing really traumatic happened to anyone while Dr. Dumbass was here, whether or not I was the one on call.
I had monday and tuesday off, so I caught up on my sleep then. Also found out I got into school at the U of A in Edmonton on tuesday! YAY!
Yay! Twice!
Oh, I forgot to mention that abnormal test results are pointed out to the docs. I wonder how that protocol became necessary? But I get your meaning.
USCDiver, I’m sure you know that to a lab tech STAT means drop everything you’re doing and do this test or the patient dies. If your patient isn’t at that level of trouble, an ASAP order or even a regular order is probably quick enough. The labs have to trust doctors to use STAT judiciously; if everything’s ordered as STAT, then nothing’s STAT.
Good for you, Nunavut Boy. I’m sure you’ll make an amazing doctor, with your knowledge of how the other side lives.
[QUOTE=Nunavut BoyAlso found out I got into school at the U of A in Edmonton on tuesday! YAY![/QUOTE]
Congratulations!
Maybe someday you’ll be a department head, scowling down at the quivering Dr. Dumbass…
In my hospital every lab, test, or radiology study that is ordered from the ER is a STAT order. We don’t do ASAP or regular orders because we are too busy. The lab and the radiology department are the rate limiting step to most patient’s visits to the ER (that and slow consultants)
Big city ERs are a medical universe unto themselves. The rest of the medical world does not operate that way.
Now I’ve worked long in both fields, where everything I ordered was stat, and also where I couldn’t get a stat to save my soul.
I hate having to break in an ER doc into primary care. If the patient isn’t about to die from it, it’s hard to get the ER doc’s attention. Just because the patient has no complaints doesn’t mean you don’t have to see them! Review their asthma symptoms and care plan with them already!!!
The only thing worse is trying to get a primary care doc to do effective ER work. They keep wanting to do preventive care! Just treat the heart attack, and let his primary doc do the diabetic foot screening exam next month!!!
I feel your pain. And as I have practiced as an RN longer and longer–I am dismayed at the number of medically unneccessary labs that are done.
If a pts K+ is 3.3 and he is given a K+ rider of say 40 mEq over 4 hrs, receives no Lasix, and is not diuresing, and is stable and eating–does he really need a stat set of lytes post rider or can’t it wait until the AM draw? Stuff like that.
I fear that I will be one cheap mother in later life, because it’s the needless expense that is bothering me-that and the sticking of the pt at all hours.
Some of the docs get it,and I am seeing more and more that are waiting for the next day’s draw, but there are those who either lack confidence or have no clue as to the cost or are afraid of the “liability” that they must know these labs NOW.
Oy. :rolleyes: and don’t get me started on the ones who order accuchecks q 4 hrs or even q 1 hr and then don’t return the calls and the pt is stuck every friggin’ hour all weekend with a stable blood sugar… :mad:
That felt good to get off my chest! 
Your ER must be a lot different from the ones around here. Here, a 12 hour wait to see a doctor is nothing unusual - after waiting 12 hours to see the doc, I really don’t think the patient needs ANY test done STAT. (And frankly, if you can wait 12 hours to see the doc, you should probably be going to a clinic during regular hours, anyway. But that’s a whole 'nother thread.)
From what I’ve heard everyone say so far, unneccessary tests seem to be the result of either the doctor’s incompetence or working in an environment he or she isn’t used to. What about the conventional wisdom that a major cause of unneccessary tests is fear of liability? Is there any truth to that?
Ha! I’ve been saying that for years! Fortunately, I work in the med field so I just ask my boss to write scrips for me, and he does. Fortunately my only life-threatening disease is treated by OTC drugs and the treatment is completely patient-directed, or I’d probably be in big trouble.
What about the practice of having routine, non-emergency blood draws scheduled for 3 or 4 in the morning? When I asked about it, I was told, “It’s because the doctors like having test results when they come in in the morning.” So the Dr’s convenience is more important than my wife, who has been up for 40 plus hours and been through a difficult childbirth, getting some rest. Gotcha.
Well if your wife’s doctor rounds from 5am to 7am and then goes to work in the office from 8am-5pm and your wife’s lab results aren’t back when he rounds, you want him to hold up all the patients in his clinic to come back to take care of your wife because she wanted to get an extra 5 minutes of sleep at 4am? You’re in the hospital not in a hotel, get over it.