Patient Education: The Good, The Bad, The Abusive

One of the responsibilities of a DCLS is patient education.  We educate patients about why their doctor has ordered certain laboratory tests, why there is a certain timing or preparation that is needed for some tests, why they should be compliant with their laboratory testing, and what their tests results mean.  Not every patient is the same; not every family is the same.  This responsibility can be just has rewarding as it is difficult, yet very important nonetheless.

The Good: I was training a patient to use a home INR monitoring testing device and how to report her results to her physician.  During this process she mentioned that she didn’t know why she had to test and what the results meant.  She didn’t like that she was needing to prick her finger to test her blood, but she said it was better than having to get her blood drawn frequently because she is a difficult stick (she said if usual “lab girl” was there it would only take one stick, but if she wasn’t it would take three or four).  I took the opportunity to explain that she has a condition that requires blood monitoring of her medication to make sure that she was taking the correct amount of medication.  I included that she takes this medication to prevent having a clot but it has to be monitored to make sure she is taking enough to prevent clots but not too much that she would have bleeding.  She then said the she had a blood clot in her leg and at first her physician said that she wouldn’t have to take the medication for more than 6 months but then later he said that she had something called “Factor 5 Lady” so she would have to be on the medication forever.  I then spoke with her about her condition, that it was called Factor V Leiden, and why it made her at a much higher risk for having more blood clots.  I spent an additional 40 minutes beyond the usual time for home INR monitoring training with that patient doing education.  What happened?  After everything was done she said “Thank you. No one, not even my doctor, took the time to explain my condition and why this was important.” Then she hugged me. It was very rewarding and gave me that “warm and fuzzy pat-on-the-back” feeling.  About 2 months later her doctor called me; he said that this patient came in for a check up and told him what I had done.  He said “Thank you – Mrs ___ has had a complete change in her attitude towards me and my staff.  I attribute that to you taking the time I don’t have to explain everything to her in terms she could understand.”   – That was a good day! 🙂

The Bad: I had a patient that came in for a “work-up” after he caught his fiance cheating on him.  In doing his work-up his HIV screen was positive.  Unfortunately, we did not have enough specimen to send out the confirmatory testing, so I called the patient’s physician to contact the patient so that he would come back and allow us to draw more blood.  The physician told me to call the patient, explain the situation (including the positive screen) and have him come back for more testing.  This was the first truly difficult conversation I had to have with a patient.  I called him and said he just needed to come back; I couldn’t have that conversation over the phone.  When he came back I took him into a private room and explained the situation.  I explained that this was a screen, why it was a screen, and we needed to do a confirmation in order to make sure.  He was visibly upset, but agreed to let us draw more blood for the confirmatory studies.  Unfortunately it came back confirming the HIV diagnosis.  When he came back for his followup, I hugged him and cried with him.  Every time he came back for his monitoring I hugged him.  He fell into a deep depression and stopped taking the anti-retrovirals.  Over the next 18 months I saw his decline into a very progressive AIDS.  The last time I saw him was in the grocery store.  He was very visibly ill; covered in Kaposi’s sarcoma spots.  I hugged him for the last time in that grocery store.  He passed away 9 days later.

The Abusive: A teenage cystic fibrosis patient spiked a fever and was admitted to the hospital.  A sputum culture was ordered and respiratory attempted collection of the sputum.  The teenager, anxious to leave the hospital and the airborne precautions required of all CF patients, spit into the cup.  OK – spit is not sputum. [For the muggles: sputum is that thick green junk you cough up out of your lungs when you have pneumonia.  Spit is from the mouth and is not representative of what is going on down in the lungs.]  This was also at a small facility that, like many other small facilities, could not afford to perform in-house microbiology … so it went to reference lab.  The reference lab utilizes a modified Bartlett Q-score to evaluate sputum specimens to ensure they are adequate for culture; essentially a way to help differentiate between what is spit and what is sputum so that only sputum gets cultured.  Why would this be important? What good, really, is a culture report that is labeled as sputum when the specimen that was received really spit? Any result would not show what is growing and causing infection in the lungs.  This particular patient’s specimen was spit and even respiratory stated that it was likely spit, but the patient’s mother was difficult to deal with in the room so they didn’t pressure the patient for more.  When we received the report that the specimen was rejected for it being spit and not sputum, the nurse practitioner explained to the patient’s mother that … yeah, you guessed it … it was the lab’s fault.  What happened next was that the patient’s mother came to the lab and began to verbally berate myself and my staff for 20 minutes.  She wouldn’t accept that her daughter simply spit into the cup.  I attempted to explain why the specimen was rejected and the scientific reasoning behind it, but she wouldn’t hear it.  The NP had already told her it was our fault.  Instead of listening she threatened a law suit, threatened calling all of the hospital board members, threatened calling the state board, and threatened calling our accreditation agency for the laboratory.  This continued in front of other patients and employees.  The hate, cursing, name calling, and threats continued for 20 minutes.  I would like to say that this was an isolated occurrence, but sadly it was not.

Patient education, while challenging, can be very rewarding.  Nothing in healthcare is easy, yet the rewards of the good certainly outweigh the others.  We are all in healthcare to help our patients.  The education of our patients is a responsibility of the DCLS that I accept with open arms.  For my fellow laboratory professionals that want more; that want to help beyond the specimen: I urge you to consider the DCLS.

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