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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Second Opinion from the Laboratory

Published November 19, 2011 3:47 PM by Glen McDaniel

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!







Do I have Genital Psoriasis??I am a gay male.  I recently have eganged in my first anal sex experience (with a condom).  After the first experience I noticed two small red spots on the base of my penis.  It progessively turned into larger red blotches that seemed to stem from the folds in my penis (as I am semi circumsized).  The spots did not itch or hurt in any way.  A few of the the spots later became mildly dry.  After a week they spots cleared up. I had sex a second time with a condom.  No spots right after sex this time, but the two days later the same spots have showed up again in the same areas.  I have done a lot of research online and all the symptoms seem to point to genital psoriasis (not to herpes or any other std).  I have other small areas of what i think to be psoriasis on my eye lid and on my arm.  Does anyone know anything more about genital psoriasis?  The information I have found isn't too extensive.  I would go to a doctor, but my insurance isn't too great.  Could sex be a trigger for this??

Mariya Mariya, sKsBvjsIhvIWnfKrdy - XXhstqDCIVonRzUF, cUAmrxza March 22, 2012 12:54 AM

That is a very good idea. I mean if  70% of medical decisions is based on lab tests it makes sense to get a second opinion on those (important lab results) that the doctor might have used in making his decisions. That is not to say the results are to blame. But if the doctor did faulty tests or did not interpret them correctly or if they were done by a doctor or nurse instead of  a med tech then the patient may need a second opinion for sure.

Roshanda December 4, 2011 9:37 AM
Waverly WY

You know we ask the pharmacist for opinion all the time. Even when a doc gives me a prescription me and my family will ask the pharmacist for his opinion and he is the one that tells us about side effects and if to take with food and so on. It is his speciality, no problem there. Should be same with lab.

Vincento B., MT November 20, 2011 1:46 PM
Jersey City NJ

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