How to drive yourself mad using just a stool sample
Step 1. Review a patient who had investigations arranged two weeks ago for ‘IBD’, only to find that the faecal calprotectin has been rejected by the lab because ‘Patient has had test done within the last month’. Except, he hasn’t.
Step 2. Attempt to explain this, and the need to repeat the test, to patient and thereby discover that:
a) He blames me despite it not being my fault
b) He is very forthright in explaining that I have wasted his time
c) He appears to view his stools as a precious commodity, not unlike platinum, and therefore does not hold back in emphasising that providing another specimen incurs much inconvenience and personal sacrifice.
Step 3. Send this specimen to the lab with a flashing neon notice attached explaining that this is a very precious stool and that they declined to analyse the last sample because they incorrectly thought that it had already been done, for some reason, but it hadn’t, so PLEASE don’t decline this specimen, not least because this guy’s poo apparently trades on the stock market.
Step 4. One week later, receive message from lab stating that this new stool sample has been declined because ‘Patient has had test done within the last month’.
The message goes on to cite the stool in Step 1 as the ‘recent test’, ignoring the fact that this wasn’t analysed either, on account of the lab thinking that there had been a previous test when there hadn’t.
Step 5. Ring duty biochemist and explain Step 4. Duty biochemist tells me to ring the lab to sort this out.
Step 6. Ring the lab and explain Steps 4 and 5, only be told by the lab person that I need to ring the duty biochemist to sort this out.
Step 7. Blow my top and say many things some of which are rude but which can be paraphrased thus: ‘Why is this happening?’ It is explained to me that the original specimen rejection was actually because the request for bloods and faecal calprotectin arrived on the same form which, apparently, the lab cannot cope with, hence refusal, but the lab GP auto-reply function has no way of conveying this back to the GP other than by saying the somewhat misleading ‘This test has already been done within the last month’.
It is also explained to me that the second sample was refused because the lab automatically assumed that the first sample had been analysed when it hadn’t, because of the two requests on one form thing.
Step 8. Swear and shout some more.
Step 9. During the swearing and shouting of Step 8, realise that the next lab report on my ‘unread’ list is in fact an actual faecal calprotectin result for the original sample of platinum stool man which the red mist has prevented me seeing, not least because it has been electronically posted after the two reports claiming that the sample has been rejected twice.
Step 10. Note that the result is normal.
Step 11. Actually scream at lab person that they should return stool specimen to platinum poo man, as they have effectively stolen it from him and he is not happy. Slam the phone down and repeat this process for similar hospital interactions at least weekly for 30+ years.
Step 12. Start barking and do not stop until someone arrives with the necessary drugs and paperwork.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield