ctPA0307 Posted May 31, 2016 Share Posted May 31, 2016 Sorry I started writing about one topic then I realized I had another question for the forum. 1) Any advice on addressing labs? I've been working for 8 months (I graduated in August). I only do nuclear stress testing so I only address maybe 2-5 labs at the end of the day. I feel that I should be more independent when addressing labs. Right now I constantly ask another PA their opinion and hoping its the same as mine which can take up a lot of time. I have the pocket clinician's guide to laboratory medicine which I use to come up with some type of plan before I talk the other PAs. 2) Do CMEs help when you're changing fields? I would like to go into ID. My elective rotation was in ID and I loved it. There is an ID board review that I was going to take that counts for 43 credits. I figured it would be a 2 birds 1 stone type thing. Basically would it help when applying for jobs? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 31, 2016 Administrator Share Posted May 31, 2016 1) What? I'm not sure I understand the question. Nuclear stress testing is quite different than most common blood work, so I would expect your SP would coach you through common plans, and how to deal with exceptions and/or involve the cardiologist him or herself. In FP, before I order a lab, I know what I'm looking for, and have a good idea of what happens if 'X' happens. e.g. on a CBC, if I get a microcytic anemia in an otherwise healthy woman who's having periods, I'm starting her on iron supplementation and rechecking in 3 months. I get that nuclear stress testing is a lot more complicated than that, but still, you need to know what to do based on commonly seen scenarios, and each time someone helps you through it, you should develop that much more independence. Does that make sense? Again, I'm still not entirely sure I understand the question. 2) Absolutely. That sounds like a great plan. Link to comment Share on other sites More sharing options...
UGoLong Posted May 31, 2016 Share Posted May 31, 2016 I've done nuclear stress testing and I don't understand your question about labs. Could you give me an example? In my world, a failed nuclear stress test often turns into a cath. Our standard labs to order a cath are CBC, chem 7, and PT/INR. Link to comment Share on other sites More sharing options...
ctPA0307 Posted May 31, 2016 Author Share Posted May 31, 2016 Sorry I just wanted to give some background. I don't order labs unless a pt has an arrhythmia during stress testing. At the end of the day labs are put into the "PA basket" which I have to address. Usually there 2-5 labs. I have to look up the pt, find out why the labs were ordered and address them appropriately- abnormal LFTs- hold statin etc. But I'm finding it hard to grasp when to hold meds or when to just repeat the labs or when to go to a doc. Hope that helps clarify my question...? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 31, 2016 Administrator Share Posted May 31, 2016 Well, the basic question on any lab when you're a specialist is "Do I have to do anything about this?" If there's something abnormal you find on labs, but that doesn't affect anything you're doing right away, then you can either do nothing (most common approach) or forward the concerning lab to the PCP (best approach) for action. Unless the labs deal directly with your specialty and you want the patient to come back for a frequent/ongoing relationship, I would defer to PCP to address labs that you think should be followed and/or rechecked. Be sure to put that in your plan (e.g., borderline microcytic anemia should be followed up by PCP) because as a PCP, your plan is the one thing I WILL read in your note. If it's mentioned elsewhere in your note, but not in the plan, then I could well miss it. Link to comment Share on other sites More sharing options...
thinkertdm Posted May 31, 2016 Share Posted May 31, 2016 I'm a little fuzzy on why the people ordering the tests aren't the ones taking care of the result. As far as I'm concerned, the person ordering the test owns the result, and it's their job to deal with it, good or bad. Link to comment Share on other sites More sharing options...
UGoLong Posted May 31, 2016 Share Posted May 31, 2016 Based on your reply, I'm assuming you're ordering a chem 7, Mg++ to see if they have a lyte imbalance that would explain an intermittent arrhythmia. For those, we'd order replacement K+ or Mg++ and then follow up with a Holter. We too review labs in the office, regardless of who ordered them. I pull up the patient's record and determine why the lab was ordered. It does take some experience, but the main decision is (a) is this person in serious danger and needs to go to the ER (like with an HgB of 5), (b) needs to go to the pharmacy where some vitamin K will be waiting for a significantly elevated INR, © needs and office appointment in the next week or so, or (d) the labs can be noted as "reviewed" and put in the patient's chart for their next visit. In some cases, the labs were ordered for pre-procedure testing, and will be acceptable or not for a cath or whatever. Statins that we start need to be stopped if the ALT and/or AST are 3 x ULN. Coumadin requires some experience, but generally we don't change the total Coumadin someone is getting by more than +/- 5-10%. Hope this helps. Link to comment Share on other sites More sharing options...
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