Patient calls, upset and panicky. She needs an appointment RIGHT AWAY!
Fine. Come on in.
What’s the matter?
She did a health screening at work, and was told her HDL cholesterol was (gasp) TOO LOW! As she described it, the nurse practitioner was very insistent that she see her doctor as soon as possible (though the form actually said it should be within two months) because her HDL was…wait for it…35.
Okay. At first glance, that looks pretty low. For women, it really should be over 50. But wait! Her total cholesterol was only 136. Given that “total cholesterol” consists of the LDL (bad cholesterol) + the HDL (good cholesterol) + 1/5 of the triglycerides, she didn’t have that much room for an HDL over 50. And indeed, another number reported on the form was the total cholesterol to HDL ratio, which is how to correct for this. “Desirable” is marked as less than 4.5; my patient’s ratio: 3.9.
Perusing the actual results form, I saw that the HDL result was highlighted, along with the line about “See your Doctor within 2 months”, but the ratio was not. I don’t know if the NP didn’t look at it, or didn’t understand its significance.
The bottom line is that my perfectly healthy (albeit somewhat excitable) patient was thrown into a tizzy over completely normal results. I’m not saying that all NPs incompetently ignore important information, but this time, this one did.
I reassured my patient as best I could, and told her to stay away from Health Fairs from now on.