Second Opinion from the Laboratory
My friends and relatives ask me for medical advice all the time. I am sure other laboratorians have the same experience. I have had a diverse experience in healthcare including being an American Red Cross trained first responder. I have also spent a great deal of time around hospitals in various capacities. But I think they just ask because I am the most "medical" and trusted people they know.
The aging mother of a friend recounted to me recent experience she had with a doctor. She is one of those sprightly, fairly healthy people who do not even have a primary care physician for several reasons.
She recently went to family practice to seek medical advice because of symptoms suggestive of a urinary tract infection (UTI). The doctor did an exam, collected some urine and did his own urinalysis including a microscopic exam. He came back into the exam room and announced he had seen "what looks like trichomonas" in the urine.
The patient (who I will call Mrs. C. for convenience) was relieved and even happy to hear that the Flagyl (metronidazole) prescribed would be administered in a single oral dose.
As the doctor explained what trichomonas was, this 70 year old protested that she had not had any sexual encounters in years. He brushed her off. She asked if she could have a second opinion and he said "Sure, but I still need to charge you for the visit, the medication and the laboratory examination."
The daughter recounting the story was incensed at how dismissive the physician was of her mother. He discounted what she knew to be true about herself. She ended by saying "I wish you were there."
Wouldn't it be great if individuals asked for a second opinion, including laboratory tests performed by a clinical laboratorian? In many physicians' offices testing is done by office personnel from medical assistants to nurses. Microscopy is often done by the physician, rather than a laboratorian, under CLIA's Provider Performed Microscopy (PPM) clause.
It would be nice to think every physician, physician assistant, nurse practitioner (or physician-extender) can recognize trichomonas or yeast. Or that debris is not confused with clue cells. But as we know not all physicians are created equal. The specimens are not always collected and examined using the best laboratory standards. Yet physicians can charge extra for performing such procedures. They make diagnoses based on these exams and bill Medicare, health insurance or the patient.
My friend's mother was right to request a second opinion; and I hope it includes a second clinical laboratory opinion as well!