Stupid blood work

I get blood work done all the time, or so it feels. Actually its about every two months for one doctor, every six months (or two or six weeks if there is a medication change for another), and then for anyone else who wants it. Sometimes I feel like there is a vampire who wants my blood.

Yesterday I had to go for blood work for one doctor's appointment next week and for another doctor's follow up request. I can't just go for blood work. I need to plan its so its before my weekly injections. Anyway I got the results this morning.

My thyroid tests are way off. This means my endocrinologist will call and probably want to change my dosage or at least have questions for me since the last time I had this test done my results were completely different than this or from the time before. Think yoyo results.

My CBC is partly okay and partly worse than normal. My MTX levels (the blood work you need with on methotrexate for my rheumatoid) are also partly okay and partly worse than normal. This means my rheumatologist may also make changes when I see her next week. Both changes, if they happen, will require additional blood work to follow the results.

I hate going for blood work. Its complicated (see above). I hate needles. They can only use one arm so options are limited. I have scrawny veins in my elbow so sometimes they have to 'look around'. Or if they wimp out, they use the big vein on the back of my hand - which is painful. Then I get to play the 'let's see what the latest results are' game and see if I need more medication changes. And go for more blood work.

Twenty Four Seven Medical Care

It has always aggravated me that if you get sick on a weekend you either wait until Monday to see a doctor or end up at the Emergency Room which is the wrong place to be unless it is a true emergency. And the horror stories of the surgical errors over the weekends because the only surgeon on call was two hours away.... I will admit that this has improved in recent years with the advent of more walk in clinics and longer hospital hours. But, we get sick and stay sick 24/7/365.

And the worst is having to wait all weekend for test results. Why can't someone read the damn test results and tell us on Saturday instead of making us wait until Monday for an answer? Any cancer person is familiar with this issue

Forbes Magazine wrote an article recently on New Year's Resolutions The Key Players in Healthcare Should Make. This issue shows up on the third page, after recommendations for doctors to improve their practices and synching electronic medical records.

So why do hospitals essentially close down on weekends? I completely understand administrative offices working a five day work week and the convenience of having all the staff available at the same time for better communication, yada, yada, yada. But why do medical staff also work only Monday-Friday? We don't just get sick between 8 and 5 on Mondays to Fridays?

There is always the complaint about too many patients coming in. But what if the hospital hours for medical care were stretched over seven days instead of five? The staff could still work the same number of hours but just over a longer period of time. And if you get a medical test, you don't need to wait for someone to read the damn report. If you were admitted over the weekend, you don't need to wait until Monday for surgery to be scheduled. I can go on.

'Bankers hours' medical care should be a thing of the past. The only people who benefit from being hospitalized over the weekend is the hospital - they get to bill the insurance companies for more nights' stays. Wouldn't it be better for the patient to be operated on over the weekend and then get out of the hospital?

What if hospitals were open for care half the time instead of a quarter (five nine hour days = 45 hours/week or 26.7%) of the time? What if hospitals were open 7am-7pm Monday - Sunday? Waits for appointments would be shorter. More patients could be treated. Patients who work full time could see doctor's at more convenient times. This is only 50% of the time, not 24/7/365 but its a big step toward more access.

I know this would require more staff but then hospitals would have less down time and would operate more efficiently and their expensive testing and surgical equipment would get used more and therefore be more profitable. And the patient's would be better treated and less stressed - quicker access to care and more information on their conditions.

Just an idea... I'm just a professional patient who hates waiting to find out the answers.

Those other second opinions

So you get diagnosed with any not-so-fun ailment because you had some tests and the radiologists or pathologists read your results and told your doctor what the diagnosis was. However, as a new study points out, not all test results are black and white.

This new study found that pathologists only agreed 75% of the time when reviewing breast biopsy results, until they met and discussed the results. The study recommends in the end that perhaps a second opinion is warranted if the results are not clear cut. Sometimes your doctor can be the one who gives the second opinion but other times, you may need a second pathologist to review the results.

I had never thought about this ever. I know I have had x-rays, biopsies, scans, etc where the doctor has added comments to what the radiologist or pathologist has said. When I was diagnosed with rheumatoid, my rheumatologist waited to get back to me on the results of my x-rays because she wanted a specific radiologist to review them because they were very good at detecting RA in x-rays.

But I had never thought of asking if I could have a second pathologist or radiologist look at my biopsy or scan results. It would never have occurred to me. But it completely makes sense. If something is subjective at all, maybe more than one person should look at it. A new point to ponder. And this study also says to ask your insurance company if this is covered... which sounds like some might cover the second opinion.

Overdiagnosed and overtested

You are diagnosed with cancer after some tests. Then you are sent for more tests to figure out the best course of treatment. You feel tested to death - too many injections, IVs, scans, and time in waiting rooms. Finally you get a course of treatment. Did you really need all those tests?

New diagnostic tests keep being developed to help determine the best course of treatment for a patient. But how much of their results are really helping doctors and patients? A recent study confirmed that the doctors see the tests as confirmation of their recommendations. And that patients do not really understand the results.

I have been on numerous breast cancer boards where women question the significance of the results of their Oncotype DX and other tests. "My results were this and my doctor said this, what should I do?"

"Fourteen oncologists were surveyed at teaching and community hospitals in Toronto. Most said the tests enhanced their confidence in deciding whether to recommend chemotherapy in cases where the best course of action was unclear to both the physician and the patient - especially when they were truly undecided. While most said the test supported their assessment rather than altering their practice, one oncologist described the test as a "tie-breaker."

But they raised concerns about overuse and inappropriate use of the test; over-reliance on the test relative to other, more established pathological indicators; the fact that testing takes places in only one lab in California; aggressive marketing of the test and its high cost, about $4,000.

Dr. Bombard said these reservations were consistent with general concerns about overuse of laboratory testing, which has increased rapidly, contributing to the financial strain on health care systems. Estimates suggest that 10 to 50 per cent of lab tests in Canada might be unnecessary and one-third of U.S. health-care spending results from overuse or misuse of tests, procedures and therapies."

This last sentence sums it up for me. Do we need all these damn tests? Just because we can test for something do we really need to?