Posted by: notdeaddinosaur | June 3, 2009

Why I Do Blood Draws

From the comments:

Do you really do lab draws for other (i.e., lazy) docs?

You’re taking on all the responsibility for handling, tracking, follow-up, and payment just to make life a little easier for those over-worked specialists?

Please explain!

Okay, I will.

I don’t do it primarily to make life easier for those other lazy docs, but for my patients and myself. For patients who still insist on galivanting about to all the various partialists, coming to me for all their blood work has significant advantages:

1. I can avoid duplicate testing.

This happens all the time. I recently had a patient with newly diagnosed celiac disease whose gastroenterologist wanted several tests. I was able to send only half the ones he’d ordered, because the others had been done two weeks earlier. I copy the endocrinologists on lipid panels ordered by cardiologists, and grab a PSA for the urologist while I’m at it. All told, I would say this is the single greatest advantage to sending the lab work myself.

2. I can add other tests that are due or indicated.

If it’s been more than three months since an uncontrolled diabetic’s last A1C and he comes from the urologist for a PSA, it’s as easy as checking off a box on a requisition and drawing an extra tube. I once had a patient come in for an electrolyte panel and noticed that he was jaundiced as all hell! I added appropriate liver function tests, and drew an extra tube for hepatitis serologies. Not infrequently, a patient will ask me to add other tests, as in, “Could you just check my cholesterol while you’re at it?” Assuming they haven’t just had it done within the last six months, I’m happy to oblige. A lab tech doesn’t have that option.

3. It keeps me in the loop.

As I may have mentioned a thousand times once or twice, I can’t always count on specialists letting me know what’s going on with my patients. When I send the lab, I know I’m going to get a copy of the results. Although my policy is to tell the patient the specialist is responsible for letting them know about the results, I know I’m going to get a copy if I’m the one sending it. That way, if the patient calls and complains that the specialist never got back to them, at the very least I know whether or not there’s anything to worry about. This is also why I don’t mind being in charge of the tracking process. If the specialist lets something fall between the cracks, it will be the patient who suffers for it, and who may decide it was my fault for sending him to that particular doc in the first place.

4. It’s an opportunity to review the chart and see if the patient needs anything else while they’re in the office.

Usually I scan the inside front cover of the chart, which is where I keep my preventive care flowsheets. Flu shot? Tdap due? Do they need prescriptions refilled? Note for a mammogram? Phone number to schedule a colonoscopy? Time to schedule a pap or physical? There’s a reason I code these as Level 1 visits, since I can almost always get in at least 5 minutes of discussion or counseling of some kind.

5. I’m a really good stick.

I have patients who go to what might be considered ridiculous extremes to let me — and only me — draw their blood. A bad experience at a lab can be traumatic. I have some tricks that result in large proportions of surprised and grateful patients.

And that’s why I send labs from my office.

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