Posted by: notdeaddinosaur | September 26, 2013

By the Numbers

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.



  1. Sometimes the Health Fair and screenings are mandatory. You did your duty. Wish my numbers were as good. Margaret

  2. I think this patient did a good bit of throwing herself into a tizzy all on her own.

  3. Oh, for pity’s sake.

  4. I firmly am of the opinion that NPs should be REQUIRED to do a residency. I can’t tell you how many asinine consults I get from I appropriately ordered and/interpreted labs from NPs. It might be easy money for me as a medicine sub specialist but it’s a waste of time and money for patients and society at large.

  5. “Inappropiately”

  6. Not to mention inappropriately ordered imaging studies, especially CTs and MRIs. Remember, folks: even a specialty NP/PA has at most 7,000 hours of instruction and training. An FP (even though it’s a fairly short residency) has over 20,000 hours. As much as the government, corporate medicine, and the nursing association lobbies want to deny it, there IS a difference. And it’s not a small one. I don’t have to think too long to decide which one I’d want taking care of me or my family.

  7. When my OB was on spring break in my third trimester they had me see the NP for my appointment. She wanted to check the heartbeat. She couldn’t find it and got panicky and said she would keep trying, and not to worry this probably didn’t mean my baby was dead. I told her I was pretty sure she was fine, because I could feel her moving in there. She didn’t even process this, and finally found the heartbeat and acted relieved like she had really saved the day!

    I shudder to think how terrifying that conversation would be somebody else. And no, I don’t have a high opinion of NPs.

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