Creating a culture of consumer advocacy for our students - PowerPoint PPT Presentation


PPT – Creating a culture of consumer advocacy for our students PowerPoint presentation | free to view - id: 835ae9-ODcyY


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Creating a culture of consumer advocacy for our students


Title: Creating a culture of consumer advocacy for our students Author: Mary Ann McLane Last modified by: Mary Ann McLane Created Date – PowerPoint PPT presentation

Number of Views:91
Avg rating:3.0/5.0
Slides: 54
Provided by: MaryAn110


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Creating a culture of consumer advocacy for our students

Creating a culture of consumer
advocacy for our students
  • Mary Ann McLane, PhD, CLS(NCA)
  • Associate Professor
  • Department of Medical Technology
  • University of Delaware
  •, 302-831-8737

CLEC 2006
  • Compare and contrast diagnosis and assessment
  • Correlate the experience gained through a CLS/CLT
    curriculum with the ability to formulate
    laboratory assessments
  • Use actual consumer questions to foster consumer
    advocacy in CLS/CLT curricula

..culture of consumer advocacy..
  • The need
  • Since 1999, over fifteen thousand questions about
    laboratory testing have come to the ASCLS
    consumer webpage team

..culture of consumer advocacy..
  • 1999 fewer than 1 question per day
  • 2005 average of 65 questions per day!

We always need and welcome new volunteers.
CI requests by discipline
Hematology 15 - 20
Chemistry 60 65
Immunology 20 - 30
Microbiology 0 5
..culture of consumer advocacy..
  • The need
  • Since 1999, over fifteen thousand questions about
    laboratory testing have come to the ASCLS
    consumer webpage team
  • To Err Is Human
  • The Quality Chasm

..culture of consumer advocacy..
  • The need
  • we dont diagnose! mentality

..culture of consumer advocacy..
  • The need
  • we dont diagnose! translates into
  • We cannot use our talents and hard-won
    knowledge/skill to make the connections we were
    taught to make in school I will be reprimanded
    if I dare to link our testing to diseases, and
    actually tell someone
  • All those case studies that we loved so much were
    just a school exercise
  • Dont ask me anything about micro since I no
    longer remember it!

..culture of consumer advocacy..
  • The need
  • Fewer clinical pathologists
  • Shorter times in the clinicians office
  • Baby boomers who question everything!
  • Other healthcare professionals easily step into
    the role of providing lab testing info to those
    with questions, despite their NOT being the
  • Nurses, diabetes counselors, pharmacists

..culture of consumer advocacy..
  • The solution
  • Realize what we do is laboratory assessment and
    not medical diagnosis
  • Just as valid as nursing, PT, pharmacy, OT,
    nutritional, etc. assessments
  • Include this as an expectation for our students
    and colleagues, alike

..culture of consumer advocacy..
  • The solution
  • Independent Practice, 2001
  • As professionals, clinical laboratory scientists
    have the requisite knowledge and skills to
    interpret laboratory tests and collaborate in
    the diagnosis and treatment of patients by
    implementing initial and reflex testing protocols
    within prescribed guidelines.

..culture of consumer advocacy..
  • The solution
  • Scope of Practice, 2001
  • Clinical laboratory scientists may appropriately
  • Advice upon the design and service scope of
    clinical laboratories
  • Advice to physicians in the appropriate
    utilization, selection and sequencing of clinical
    laboratory tests and, in collaboration with
    attending physicians, determining clinical
    correlations and interpretations of the quality
    and utility of specific laboratory results
  • Advice to other users and consumers of clinical
    laboratory testing services upon appropriate use,
    maintenance, quality assurance and other
    procedural and informational requirements.

..culture of consumer advocacy..
  • The solution
  • Direct Access Testing, 2004
  • it is the role of certified clinical laboratory
    scientists to consult with consumers about the
    purpose of laboratory tests and the general
    meaning of laboratory results in whatever setting
    those test results are generated, including
    direct access testing.

A first step for developing the culture
  • Junior/senior level CLS courses
  • Insights into the legal, ethical and
    user-friendly aspects of responding to consumer
  • Use of questions from ASCLS Consumer Webpage

A first step for developing the culture
  • Depth of knowledge needed is very obvious
  • Hints at need for continuing education after
  • Questions more realistic than synthetic ones in
    most texts
  • Will automatically contain not just the question
    but the anxiety, the confusion

A first step for developing the culture
  • Topics easily interwoven
  • Quality assurance Clinical Correlations
  • Statistics Empathy
  • Method comparison Ethics
  • Attendance at annual Legislative Symposium
  • Legislators need to be educated, too!

A first step for developing the culture
  • University of Delaware syllabus for MEDT401
  • Patient Advocacy within the Medical
    Technologists Scope of Practice

Hematology Examples
  • My hematocrit was 16 and I had to have an
    infusion, but I am still suffering with
    headaches. Is it normal to have headaches with a
    low hematocrit?
  • My WBC is 3.2 and the range is 4.0 10.0.
  • The doctor told me my lab tests were fine, but on
    my copy there is an H next to the MPV of 10.7.

Just a little information, please
  • I was wondering if you could answer a question
    about leukemia for me. I need to know what types
    of blood tests are done on what types of cells
    and possibly a few details on each of them to
    diagnose leukemia.

Healthcare provider examples
  • What is the quickest and most efficient way for a
    patient to increase their hematocrit level?
  • I just had a routine physical exam. Im an RN
    and would like to know what a platelet count of
    700,000 and a WBC of 21,000 indicates. Why am I
    being sent to a hematologist?

Worried mother
  • My son is a 5 years and 3 month old Chinese boy.
    His segs is too low and his lymphs is too high.
    He did not have any symptoms when I brought him
    for the blood test. I am really concerned. Do
    you think he may be infected with HIV. Do you
    think he may have leukemia?

Patients right to know
  • I just finished treatment for dysgerminoma and
    had my follow up blood work. I am concerned about
    my eosinophil percentage of 34.0 when the range
    is 0-4. I called my oncologists office and the
    nurse told me that the only thing they look at is
    WBC, ANC and MONO and that patients should not
    receive copies of their blood work because they
    dont know the significance of anything and they
    would tell ME when I should be concerned.

Frustrated daughter
  • All I am trying to find out is what the effect on
    the body of someone having a very low (1,000)
    platelet count is. My mother has been
    receiving platelet infusions.
  • Several messages later - diagnosis of RAEB
    (Refractory anemia with excess blasts) trying
    to make decision to continue treatment I
    referred her to social services at her local
    university, mentioned hospice and sent her
    information on MDS (Myelodysplastic Syndromes).

Good teaching material
  • RBC 3.69 x 109/L (4.1-5.1)
  • HCT 24.1 (35-47)
  • HGB 7.3 g/dL (10.9-15)
  • MCV 66.2 fL (80-100)
  • MCHC 30.3 g/dL (33-36)
  • Fe 2.7mmol/L (6.6-26)
  • Ferritin 3 µg/L (30-180)
  • I have been very tired and all I want to do is to
    eat ice. What do you think my problem is?

What is your assessment?
A chance to educate patients
  • My hemoglobin is 14.2 and my ferritin is 13.2
    (20-120). How can my ferritin be low when my
    hemoglobin is good. Dont they both involve iron
    in your blood?
  • My father just had blood work done and his HGB
    was gt20.0. He has lung problems and is a heavy
    smoker. Can smoking and lung disease affect his

Coag Examples
  • I take Coumadin and I used to get my PT results
    in seconds. Now I get an answer called an INR.
    Is that a new test? Nobody can explain to me
    what it means just that it is the way the
    report is now given.
  • What are the symptoms of an INR of 8.0?

Scary, but with a happy ending
  • I had been on coumadin for a month without any
    monitoring. I wanted to get off, so the doctor
    ordered an INR. It came back 11.1 and he called
    me at work to come right to his office for a shot
    of vitamin K.
  • The doctor apologized. Three days after the
    vitamin K shot, my INR is 1.6. No one told me
    that I could not take fish oil or that there were
    any diet restrictions while taking coumadin.
    Thanks for all your information.

This is a foreign language to me
  • I was found to have an elevated APTT in pre-op
    screening. I have never had any bleeding
    problems. I was told that I have a lupus
    anticoagulant as evidenced by the positive hex
    phase study, elevated ACAs and inhibitory pattern
    in multiple factor levels. I was told that
    because of the lupus anticoagulant that I might
    be at increased risk of post-op thrombotic
    episodes. What does all this mean in plain

Some questions are fairly easy- and some more
  • What is thrombosis?
  • Why would my physician suggest that I take a baby
    aspirin every day??
  • My daughter has been diagnosed with Klippel
    Trenaunay Syndrome. Her doctor wants to start
    her on Coumadin. How does that relate to KTS?
  • My baby has been diagnosed with Kawasaki
    Syndrome. Is it usual for the platelet count to
    approach 1 million?

Chemistry scope of questions
  • A recent test indicated my ALT was fine but my
    AST was 15 (the range being 16-40). What does a
    lower number mean? Is this dangerous?
  • What is standard crininine level for a 67 yr. old
  • What is the BCP cholesterol test?
  • Hi, Can amas test for cancer ? can you do it?

A pharmacopeiaand the thick PDR
  • I am on 1 mg of Primogyna dailyiron tablets,
    garlic, gelatin capsules, brewers' yeastGinko
    Biloba and NoniCozaarAllegra, Nasonex, and
  • If taking a c-peptide test how would the drugs
    Amaryl (glimepiride) Avandia (Rosiglitazone
    Maleate) I am taking for diabetes affect the
  • I am taking eltroxin since 1998. St.Johns
    WortDepakote, mebaral lipitor

What could that possibly be???
O presente texto está na lingua portuguesa
(Brasil) e os exames são de minha filha Raquel
que apresenta icterícia, cefalopatia,
colecistopatia acalculosa e tem 21 anos de idade
e gozava de perfeita saúde. Não consome alcool ou
outra droga qualquer, exceto um remedio
recomendado pela dermatologista de nome
Flutamida. Eu ficaria muito grato com suas
explicações para os resultados dos exames que
transcrevi abaixo Bilirrubina direta 7,10 mg/dl
Bilirrubina indireta 4,90 mg/dl Bilirrubina
total 12,99 mg/dl Material sangu Método
Jendrassik mod.
  • The test is a HRP test. It's either related to my
    heart disease or my diabetes.
  • What is a gamma test? I have results but I dont
    know what it is for. Is there a charge for this
    service, if so please disregard my message, thank
  • My 77-year-old father has been asked to have a
    "12/60 creatinine" test.

Do they really mean that?
  • What is the significance of elevated nitrates in
    the urine?
  • I had a test to determine my blood glucose level
    since I have type 2 adult onset diabetes
    hemoglobin A1c 5.6 I was expecting a reading
    similar to the blood test results that I get
    daily on my glucometer. How can I interpret the
    lab results? Thank you.
  • I am interesting to know the test for cinetic
    creatinine concernig to eliminate the cromogenous

youre thinking of doing what?
  • We are exploring this test in our ED. I am
    interested in getting information on the
    technique used to perform the test (I know the
    sample is placed in a cartridge which is placed
    in a portable meterwhat I dont know is whether
    the reading is by mass spectrometry,
    electrophoresis, or some other technique). Do you
    have any information? Thanks in advance for any
    assistance you can provide.

Interpreting laboratory jargon
  • Subject   Urine cultureWhat does mixed
    urogenital flora, less than 10,000 colonies/mL
    effect the test results?

Uh Oh!
  • During an annual exam my docter advised me that I
    may be infected with chlamydia. I have been
    completely faithful to my boyfriend of three
    years, and have never had an issue with previous
    exams. Could I still have gotton this if my
    boyfriend has been faithful to me? I have heard
    that in some cases an STD can go undetected for
    some time is this true?
  • I know that Trich is a STD but what causes it
    exactly?  Also who gets it first a man or a

Questions from physicians
  • Given results below were the husband and wife
    ever exposed to HepB, are they currently
    infectious (acute/carrier), is further testing
  • Wife Retest Results Nov/04
  • HepA-AB(IgGIgM) Negative
  • HepB core IgM AB Negative
  • HepBs Antibody lt10 Nonimmune
  • Wife Second Retest Nov/04
  • HepBs Antibody lt10 Nonimmune
  • Husbands results Nov/04
  • Surface Antibody (Anti-HBs) lt2.0
  • Liver Markers Normal
  • Antibody (Anti-HAV) Not detected
  • Question Patient was screened for HepB as part
    of pregnancy blood testing. No known risk
  • Wife Results Oct/04
  • HepB-HBsAg positive
  • HepB-HBeAg non reactive
  • HepB-Anti-HBe reactive

What do you think?
HIV serology
  • What are these numbers (ie. 0.30 etc) and why do
    they change? 
  • If I am HIV Neg why is there a reading at all?
  • This is very confusing and I asked the nurse at
    the clinic where I got the results who said the
    number is just something to do with the type of
    test but to me it seems to be some kind of
  • Hi - I would just like to know what the numbers
    mean on my negative HIV test results.  My print
    out is as follows for 4 tests since May 2004.
  • May 2004 AxSym HIV  0.30 HIVNG
  • Jul 2004 AxSym HIV 0.29 HIVNG
  • Oct 2004 AxSym HIV 0.40 HIVNG
  • April 2005 AxSym HIV 0.30 HIVNG
  • Test - AxSYM HIV 1/2 Ag/Ab MEIA

Obsessed by HIV
  • hi ascls,this is me againthere is something i
    still cant get convinced enough about the blood
    circulation of the eyes..well, does the blood
    from the eyes flow thru down the body..? but i
    just wonder does blood in the capillaries of the
    eyes flow back to the body..? this question is
    crucial to me as im afraid hiv virus might get
    into the eyes as for my past encounter of the
    semen gettin to my eyes..
  • (And then, 7 e-mails later)i recently had a
    couple of dust particle from my shoe went into my
    coke drink..will i get any hiv disease drinking
    that lot of dust in the drink or pose any danger
    to my health?

Why me?
  • I have bugs-yes bugs- in my urine. I noticed in
    the toilet little things floating upon closer
    inspection with magnifying glass there were
    lots...of them swimming. I went to my doctor who
    did a urine test, said
  • I had infection gave me 30 cephalexin caps.
    I've taken all of them which has been 10 days but
    I still see some bugs lots lots of eggs in
    all different stages of development.
  • I think the bugs I pass now are not alive
  • but why are there still so many eggs
  • when will they be gone?

  • Typical questions include
  • ANA
  • My ANA came back positive. the Titer was
    1320 and speckled what does this mean?
  • RF or RA
  • I had been tested for RA 6 years ago. I have
    my medical records and I don't know how to read
    it. What test would hev been ordered and how
    is it abbreviated? Also what would the test
    results look like? Lab test ordered under what
    heading would I find the info? thanks very much

Other Questions
  • am a 49 y/o female, my lab results are the
  • complement component
    .130.03complement component
    .......10.71are these within the normal range
  • Is this (antiphospholipids) the same as
    anticardiolipin antibodies?

Some Questions Are Different...
  • Can you tell me how many serological celiac tests
    are done annually in the US? Thank you.

And My Personal Favorite Question
  • Can you get pregnant from oral sex?

And there are times wed rather not know
  • I am a 17 year old male and i have a 2 inch
    penis.  I am emailing you to find out will my
    penis grow any more.  If no, is there some type
    of medication (that works) and is to increase my
    penis.  It is kind of embarrising not to have a
    girlfriend or take a shower at school.

Truly legal implications
  • How does one test for the presence of semen in a
    sample of womans underware? I have several
    samples I have collected, but dont know what to
    do with them. Please help. Thank you.

Unique outside research needed to answer some
  • do you think that if doc ock used amylase and
    starch hydrolysis he could defeat spider man?
    (listed as a health care provider!)

then theres always back to square one
  • what does protective mean on the green level

And what do our healthcare colleagues ask?
  • I am a pharmacist and would like to know what
    electrolytes testing tells a doctor. Also, is
    there a web site that would tell tell me what lab
    testing reveals to a doctor? What is so
    important about a relation between Sodium and

And what do our healthcare colleagues ask?
  • I am a physician. What are the effects/consequence
    s of pancreas removal?
  • As a nurse, I am curious if you can tell the
    difference between inherited and acquired osmotic

Time to challenge the clinician!
  • I am 28 years old from the philippines. I had
    this bad headache at the back of my head. Its
    agonizing. for almost a month its attacking once
    in a while but lately more thank a week now the
    headache is getting worst. So, i had an ESR test
    and it say there the normal range is 0-20 but my
    result is 40. But the doctor ask my age and I
    said 28 and he added 14 into it that makes it
    normal he said. so, am not really sure if what he
    said is correct. so, pls. let me know so they're
    be light into this matter.

Other resources
  • Join the consumer webpage information team!
  • Immediate access to thousands of questions saved
    by other team members
  • Incredible experience definitely making a
    difference in the lives of patients
  • Great role model for your students!
  • Possible book?

Other resources
Student responses
  • I enjoyed going over the questions from the
    consumer webpage. It really helped me not only to
    increase my knowledge of clinical chemistry, but
    also to see another side of being a Clinical
    Laboratory Professional. It reinforced that we
    need to be able to communicate with patients as
  • Discussing the questions from the consumer
    webpage forced me to understand the material more
    and be able to communicate that knowledge to
    patients.definitely a critical thinking