Waiting on blood tests
Posted on 1 November 2012 by Melody Clarke
My patient hasn’t had his blood test. I told him when he needed to get it done. I checked on the computer last week, I checked again today. Still no results. I give him a ring.
‘I don’t seem to be able to find your blood test results on the computer,’ I say, tactfully trying to explore possible reasons for the absence of results. He is apologetic, he still has the form, he’ll get it done tomorrow. It’s important because I want to know whether it’s safe for him to continue taking his medication or not.
Regular blood tests are one of the hassles of long-term medication, but if I’m going to be responsible for writing a prescription, I need to know that it’s safe. Tomorrow has been and gone, but there is no sign of the result.
I’m trying to develop my own system of reminding myself to check for Mr X’s blood tests on a certain day, and Miss Y’s bloods on another; then I can call them up and tell them that it’s safe to go on, or that they can increase their doses if necessary, or that they need to drop them a bit.
Others use paper diaries or email reminders. But if you tell someone that they need to get their blood tested on a particular day, then they probably won’t do it. Sometimes I get the patient to ring me when they’ve had it done, then I can check the results and send them a new prescription. Some hospitals have computers on which you can’t get past the log-in stage without signing off all the results you’ve requested.
But I worry that if I don’t know when the test is done, then I won’t know when to check for it. I worry about the patient who will get his test done only for his result to float on a piece of paper around the universe for a bit before making it through the hospital post and on to my desk six months later. By then, I expect I’ll have moved on to another hospital and my successor will get the meaningless, out-of-date abnormal blood test result to sort out.
We prescribe medication assuming that it will be taken. We give patients blood forms on the assumption that they’ll get them done. To what extent should we expect patients to take responsibility for themselves?
Compliance with therapeutic drug monitoring is essential for safe and effective treatment. Patients can’t always see the practice nurse on the day their bloods were due; they can’t always get their bloods done on the day I’ve wanted them to; forms get lost, people forget.
I’ll try again tomorrow. I’ll press on him the importance of getting his blood tested, but if he doesn’t get it done, then I’ll have no choice but to stop his medication.
Melody Clarke is a junior doctor
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