Tests, results and being informed
How do you treat going along to your GP practice for bloods and other tests?
Do you know exactly what they are testing for? Have you asked?
(I did last year when they wanted to run, as they put it, "a blood test!"
But when I asked precisely what they were testing for, it trasnired there were
ten tests they were running! I wanted to know why!)
Ever wondered why they take loads of blood and put it into four or five vials?
What all are they testing for? Do you know? Do you ask?
And when the results come back, are you content just to have them say, “
Your results were fine?” or do you ever stop and ask,
“What was the result of EACH test?”
Ten in, ten out
Even if just one sample of blood is drawn, if you are being tested for ten different things, then you must ask for ten different results.
The slapdash, random way tests are taken without giving us specific information as to what and why,and the even more generalised way results are given, has to stop!
How can you the patient be informed if you do not get the results? To make wise decisions you need the fullest of information.
On what basis can you make informed decisions about your health if your GP or nurse deny you the detail of test results?
I asked a GP recently why we as patients, in this day of empowering patients to make informed decisions, weren’t given a printout of the results and the response was – wait for it, drop jaw in amazement – “Patients wouldn’t be able to understand them!” What arrogance, and what an insult to a patient’s intelligence. It is not for him to judge my capacity to be able to assess the results.
Let’s use an annual diabetic check as our case study – a real one, my own.
The annual check for a person diagnosed with diabetes
There are fifteen health care essential checks which a person in Scotland, diagnosed with diabetes Type 2, must have each year.
I have lived with such diagnosis for 20 years and only in the last two years have I had anything remotely approaching that number of checks.
Knowingly I have had only 50% of the checks done.
Here are the checks What I have had since 2013 as part of annual check
Blood glucose levels measured (HbA1c blood test) Yes
Blood pressure measured Yes
Blood fats measured No results given, even if taken
Eyes screened for signs of retinopathy Yes
Feet checked Yes
Free flu vaccination Yes
Kidney function monitored Yes
Legs checked No
Ongoing, individual dietary advice No
Get emotional and psychological support No
Be offered a local education course No
See specialist healthcare professionals No
The chance to talk about any sexual problems Only once & not pursued
High-quality care if admitted to hospital n/a
If you smoke, get support to quit n/a
Information & specialist care if planning to have a baby n/a
The problem with the above is that they are fine if the results are discussed, but not so fine if all you get, as I get, “Your results are fine!” Then there is an attitude of, “And that’s it.” There is no discussion initiated, unless I initiate it, about my health and well-being, how I am finding living with diabetes.
On my most recent check-up, the conversation was not at all pleasant.
The nurse was clearly seeking to rush through HER agenda and although she kept saying, “I am listening, I am listening” she clearly was not! Anyone who keeps having to remind you they are listening is blatantly not! You demonstrate listening - you don't tell someone you are!
At one point I said I felt she was not taking in what I was saying or asking, to which her reply was – “There is nothing as a nurse I can add to what you are saying.” Well why not share that process? Why barge on with her agenda?
Another point she asked me a salient question and I began to reply – straight away she stopped all eye contact, she started printing out a label to put on a urine-sample bottle, she was tapping into her keyboard, and she was trying to fix me up with a blood pressure monitor.
Again I asked – are you really listening to me? And she stopped what she was doing, gave me eye contact, and pushed her chair back from her table as if to face me. By then, all trust in her had broken down.
She asked if I used the MyDiabetesMyWay website to inform myself and I said, “Yes!” but explained why I felt the website was not a good source of information. It’s information on my test results is not comprehensive. (See below) She then replied, “Oh I wouldn’t know I have never looked at the website!” So here we are in an annual diabetic check-up, a nurse is recommending I look at a specialist Scottish run website, and hasn’t even bothered in her career to find out what it can offer!
She then advised that although the check results were good, they showed that I was not taking my statins. Well in truth, it does not tell that at all. Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood. It is the latter count that would have been high. I explained that after much research I am unwilling to take statins.
Her eyes rolled, she drew in breath and then said, “I wish patients would stop using the web!” This from the woman who seconds earlier had been recommending its use for a website on which she was ill-informed. This from a woman clearly anti the web, and not knowing there are many official and reputable websites giving a plethora of information on the latest on statins. As with her information on statins, she was grossly outdated in her attitudes and information. She simply has a blanket – “I don’t like it when patients inform themselves” attitude.
LDL cholesterol is often referred to as "bad cholesterol", and statins reduce the production of it inside the liver. But there is no evidence that says that cholesterol is bad for you. But plenty of evidence to say that the need to treat rate for statins, ie their success rate, is that they benefit one in three hundred.
Why believe them?
Based on information at 6th April 2016, the following shows that if I go looking for the information the nurse recommends, I will only get four results out of nine! Of what use is that?
HbA1c: 57.0 mmol/mol (7.4%) on 06/04/2016
Blood Glucose: [no result]
Blood Pressure: 133/70 mmHg on 17/11/2015
Total Cholesterol: 5.5 mmol/L on 06/04/2016
HDL Cholesterol: [no result
LDL Cholesterol: [no result]
Triglycerides: [no result]
Creatinine: 98.0 umol/L on 06/04/2016
Albumin / Creatinine Ration: (no result)
Those are my actual results – why are there so many “no results”. And given "no results" for Cholesterol, why prescribe me statins?
Two things must happen:-
When a patient turns up to have bloods taken for tests, they should be informed exactly which tests are being performed
They must be given the full results – not just a nurse saying “Tests are fine!” then claiming one isn’t.
The patient is not informed. But these are the days of empowering patients, putting them in the driving seat, and being patient centred. The patient needs information to do that otherwise we are still back in the paradigm of medical person retains control. Knowledge is power! And they know it.
What to do
So if you are to have tests, any tests, ask:-
What are they for?
What exactly is being tested
How will the tests be done?
How detailed are the results I will get?
May I have for each test done, the exact result?
May I have copies of the results before then consulting with any medical member of staff?
And if not, to any of the above, why not?
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