The Medical Thread: We're experts on everything else; why not?

[SonofSouthie]

Thx

[dxmnkd316]

Slip and fell in work yesterday. Surgery this am for a fractured left hip.

oh ****. Godspeed on your recovery

[burd]

Slip and fell in work yesterday. Surgery this am for a fractured left hip.

Ouch! At least it happened at work. Get well.

[dxmnkd316]

I can't remember where we were talking about releasing test results, but I think today was a reminder of why it's probably better to not release test results to goobers like me before your doctor sees it.

Got a result. Nearly had a heart attack reading through it. Turns out it's an exceptionally common and easily corrected issue. Despite the fact that the result said the result was abnormal and... extremely abnormal at that.

[St. Clown]

Did Igor fetch you a brain?

[dxmnkd316]

Did Igor fetch you a brain?

Lack of brain does seem to be a common issue these days.

[Kepler]

Did Igor fetch you a brain?

Abby Someone.

[WisconsinWildcard]

I can't remember where we were talking about releasing test results, but I think today was a reminder of why it's probably better to not release test results to goobers like me before your doctor sees it.

Got a result. Nearly had a heart attack reading through it. Turns out it's an exceptionally common and easily corrected issue. Despite the fact that the result said the result was abnormal and... extremely abnormal at that.

Its the law. It sucks in many cases but they have to be released. It is frustrating as I typically get results to patients (actually call the patient most of the time) within 12 hours of release...yet often my patient is already freaking out. Sometimes appropriately, most often not.

[Swansong]

Its the law. It sucks in many cases but they have to be released. It is frustrating as I typically get results to patients (actually call the patient most of the time) within 12 hours of release...yet often my patient is already freaking out. Sometimes appropriately, most often not.

Yup. The 21st Century Cures Act prohibits any information blocking. Clinical data must be released without delay and cannot be systematically suppressed, with very few exceptions. I have spent a ton of time on it, as it's been phased in over three years. Right now, the final phase is to require healthcare providers to release this data in a computer-readable form (I'm not sure if it's HL7 or XML), which my company is currently working on.

It does, however, lead to a lot of ethical issues, and our ethics and legal departments have and continue to work out exceptions:

• Patient direct request.
• PHI that includes a different patient's PHI
  • newborn documentation that includes pertinent information on the mother, for example
  • Any reference to another person's health info that is actually relevant to this patient (so, "family history of xxx" doesn't really count, but "father had xxx condition" might)
• Concern for imminent self harm or harm to others if information is delivered via patient portal
• In MA, state laws greatly restrict sharing of info related to HIV/AIDS, so we have to suppress anything even remotely related to that
• Organ donor/recipient documentation, at least the clinical documentation on where a patient sits on a waiting list

Ultimately, I think transparency is good, but unfortunately it's shined a bright light on how awful health education is in our country.

One benefit from this is that we've had a lot of patients pointing out documentation mistakes, which we then need to correct. Someone abstracts the wrong problem list and then that just propagates through every progress and H&P note ever after.

[dxmnkd316]

Huh. Interesting. That's a dumb law. Should be something like 48 business hours after test performed it should be released. Give the doctor a chance to properly frame the result.

My wife had an interesting take on this. Since she's a licensed therapist, results of her assessments and tests are usually not released immediately. It can be a huge risk to her patients if "diagnosis: bipolar, etc" is released without other info or discussion around it.

Edit: I see Swansong mentioned imminent risk.

[Swansong]

I think a lot of mental health therapy notes are able to be suppressed too, but I can't remember the specifics.

[leswp1]

Its the law. It sucks in many cases but they have to be released. It is frustrating as I typically get results to patients (actually call the patient most of the time) within 12 hours of release...yet often my patient is already freaking out. Sometimes appropriately, most often not.

Added to the list of things that make me happy I am retired! I have family that like to look at the results, consult Dr. Bing, declare themselves experts and are already on the warpath to get what they think they need probably before the Provider or Nurse has even figured out there is a result.

Another interesting foible related to this- the number of times staff, Docs, medicals have assumed that we have seen the results to tests FIL les has had done and expect us to know what is going on or asked when we looked on the Portal, like it is our job. We don't have access to the Portal for FIL les.

[leswp1]

Update on the fiasco that is the medical system. Turns out the local hospital let go most of their lab staff, contracted with Labcorp. The Rehab has contracted with another lab. No such thing as reliably stat labs unless you are admitted in house. Even ER has trouble with some labs.

THankfully FIL les survived and is home but the complete incompetence of the lab systems is really frightening. Last week he spent >20 hours in the ER or being transported from the Rehab. First time he had labs drawn and his Hgb was 5.39 (Holy ****!!!). No one called anyone. They faxed labs over at noonish --> trip to ER for transfusion- didn't get home until past 1AM.

Second time he was 5.8, they decided to order a redraw the next day (no one let us know). The results were low, they called at 1 for mr les to transport him to the ER. He was there at 1:30. Sat for 5+ hrs before he was put in a room and then another hour before anyone saw him. By that time he was hemoconcentrated from dehydration so they didn't think he qualified for a transfusion. They finally re-ran labs, he got transfused. Back in his bed after 1AM.

A few days later they ordered blood and scheduled a bed for a transfusion. The lab never drew the blood. The facility called for them to come out to draw blood. They have 4 hrs to respond. After 5p we got a call that no one showed up to draw the blood. The infusion bed was cancelled. They reordered labs. No bed available for 2 days. If abnormal he has to go to the ER again. He has already said he won't go. Thank God he was normal.

THe Nursing staff are superstars. The system ... It would be easier if he were in a 3rd world country where the system works by paying. Here- the system just doesn't work. Even with the 2 of us having decades of experience, calling, asking for a contingency plan, advocating, there was no way to circumvent the completely dysfunctional system. Thank GOd FIL les has the constitution of an ox. WIth his hx (cardiac, diabetic, recent ARF) a count like that could be deadly.

[French Rage]

Anyone know anyone with an LVAD? Father-in-law might be getting one shortly, wondering if anyone has any stories on them.

[psych]

Bless him. Is he retired?