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Press Start: Lead an Empowered Life as a Clinical Laboratorian

What's Your Favorite Archaic Test?

Published April 15, 2008 9:26 AM by Glen McDaniel

As a student, one of my professors prided himself on being a CLS historian of sorts. He would regale us with tales of old tests, methods, instruments and innovative efforts to make do under trying circumstances. In our eyes, he was the McGiver of CLS! When we did our clinicals at the local hospital he showed us the tank out back where they used to keep frogs for doing pregnancy tests. He had an old Natelson blood gas instrument, a colorimeter with removable glass filters, and insisted that we do methods manually to comprehend the principle before we took the "easy route" of automation.

Most recent grads today cannot even fathom taking all day to perform fecal fats or doing a batch of enzymes with stopwatch and a water bath.  If you talk about the need for producing a protein-free filtrate, you would most likely get a "huh?" In fact, now watching an instrument take 15 minutes to churn out a result is way too long! I am fascinated by details of old tests, old instruments and making do in the early years of your practice.

Please share some of those old stories with us here. I know there are some old-timers out there still practicing medicines who find it hard to relinquish an old test that has outlived its usefulness.  In an article I read recently, expert laboratorians, not surprisingly, gave the boot to LE Cells, Schilling Test, FTI, Bence Jones Protein and others.

They also fingered more controversial tests like ESR, LDH, AST and even CKMB for being superseded by more specific tests in recent years, What do you think?  I am also interested in hearing what is your "favorite" (or most annoying) useless test requested in your lab currently or fairly recently?

posted by Glen McDaniel
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7 comments

There is not one test that does the diagnosing. Usually the Dr. will eulavate your symptoms and ask lots of questions about your daily functioning. Some will have you do a Beck Depression Inventory to judge the severity of your symptoms.They may ask some questions about your personal or family history. They will also observe your behavior and body language to help them decide.

Merifet Merifet, dWHtPLRjqyAPB - Merifet, HDuAgqByXWPhiWN July 20, 2012 10:38 AM
rdkNXafmIiCkWWJH KY

Perthena:  Wow! I am the king of trivia and I have to admit I have never heard of that test. I Googled it and found quite a bit of info.

Cynthia: I might be dating myself, but I certainly remember all those tests you mention. I recall making up various substrates and standing before a water bath with lines of tubes doing enzyme assays. We sure have come a long way, havent we?

Glen McDaniel May 27, 2008 5:31 PM
Atlanta GA

My all-time favorite useless test was called a photomotogram, for measuring a patient's "thyroid level".  The patient would kneel on the edge of a chair seat and we would pass a light beam through their Achilles tendon and tap it with a rubber hammer.  This was all hooked up to an EKG machine which registered the amount of reflex action.  This was 1968 in rural Alabama.  From photomograms to molecular technology, what a trip it has been!

Perthena Latchaw, MLT - Program Director, Seminole State College May 20, 2008 2:13 PM
Seminole OK

Recently I received the following email from a reader who wants to remain anonymous. The reader makes some extremely salient points including pointing out that sometimes archaic tests are chosen because the performer (such as an independent commercial lab or  pathologist) has a vested financial interest.

I was also very impressed when the reader indicates that in his/her laboratory, they have made the clear unequvocal decision not to perform useless or clinically inappropriate tests. That is one lesson many of us could learn-we do have the right aand option not to go along with a test simply because it's been ordered. This is not without political and legal pitfalls, but it certainly can be done.

Here's the email:

> In a message dated 5/9/2008 8:31:22 P.M. Eastern Daylight Time,

> Hello-

>

> I work in cytology. How about the maturation index  in-lieu of

estrogen/progesterone levels, ( to save money). Barr body  testing instead  of a cerotype to identify Kleinfelters etc (to save money).  We get requests for these occasionally and refuse to perform them,  recommending more accurate tests, especially for such profound diagnoses as  genetic  abnormalities.

>

> Along the same vein it, is high time to boot  the conventional pap smear for ThinPrep paps and imaging. By the way  ThinPrep imaging is a much better methodology than the Surepath focal  point, which is being used by the pap mills, due to decreased cost and  personnel by archiving of 25% "low risk"  having no cytotechnologist  review at all, losing an adequacy

evaluation, a hall mark of the Bethesda  meetings to improve cervical screening.

> HPV Digiene is a loser compared to  the now available real-time PCR for HPV testing. Not all "archaic" testing  is found in the distant past. Finances ( cost reduction) and quality lab  testing are often at odds.

> The Gardasil vaccine is not a panacea for  the coming cytotechnologist shortage, due to closing schools and the baby  boomers retiring. It only is  effective against viral types that cause 70%  (at best) of the cervical squamous cancers. It is not recommended for  people already infected and we will not have 100% vaccinated due to cost  and compliance.

>If you subscribe to evolutionistic theory, survival of the  fittest would dictate the 30% of  the viral  types not protected  against, will soon dominate.

> HPV testing cannot be correlated with  cervical biopsies and gives no information concerning the pathology of the  cervix. It should never be  allowed to replace the pap smear, which can be  correlated with biopsies and is MORE sensitive to cervical pathology than  even cervical biopsy,  which often have to be repeated to confirm the SIL  detected by the  original pap smear.

>Money again is driving these  propositions, not  quality lab testing. Things will only become more dire,  if government health care is adopted and cost containment is even more a  factor. Pathologists and  corporate pap mills should look at their  conscience and motives, when  choosing lab testing. The pressure from  liability issues to relegate the  pap smear to being an archaic curiosity,  must be alleviated, before we  lose the most effective cancer screening  test.

> Name with held.

Glen McDaniel May 14, 2008 7:09 PM

Hands down least favorite was "Red Cell Mass and Plasma Volume."

This is when Pathologist removes volume of blood, you tag with Isotope, Path reinfuses, then after a specified time, a venipuntcure to measure tagged cells.

After measuring radioactivity of pre, infused, and post samples (some needed careful dilution, too), there was a complicated

formula to arrive at the Red Cell Mass and Plasma Volume that Physician used in dx red cell proliferation disorders.

This test was nerve wracking and time consuming with much calculation.

I don't think the patient enjoyed the process, either.

Rosemary , Transufsion Services - MT, SNGH May 6, 2008 11:55 AM
Norfolk VA

Don't forget the thymol turbidity test or the cephalin flocculation test!  How about making up reagent for doing lipases with olive oil and having to wait overnight for the results?  I actually performed Folin-Wu blood sugars for real and remember boiling BUNs and hand-titrating chorides.  The flame photometer was always fun (not!) when you were under the gun to get stat electrolytes out.   And the fun we had playing with the toxic mercury from the Natelson microgasometer!  They weren't the good old days!

Cynthia, Blood Bank - MT(ASCP) S.C., Pocono Med, Center May 5, 2008 10:15 PM
East Stroudsburg PA

I have worked at three different small hospitals that all perform ESR, LDH, AST (the hospital in West Virginia at which I currently work as a traveler still refers to it as SGOT, LOL), and CK-MB (called CPK-MB at the above-mentioned facility).  I graduated from MT school at a large hospital in Winston Salem whose hematology lab has a "stat" 5-minute ESR machine that uses capillary tubes.

Our lab exercises in the didactic Clinical Chemistry course all involved the good old spectrophotometer in winter 2003/2004; the class after mine got a more modern bench-top chemistry analyzer (no fair!).

Also, most of our time in the coagulation section of our clinical training in the laboratory was spent performing PTs and PTTs on a fibrometer four short years ago. LOL

Stephanie Mathis,MT(ASCP), Generalist - Medical Technologist, Medical Staffing Network April 15, 2008 4:03 PM
Danville VA

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