As a new tech working evenings I was confronted by a physician’s assistant who questioned a negative pregnancy test. She demanded that I repeat the test, and as she watched over my shoulder said, “Are you sure? Those clumps mean she is pregnant!”
Our urine pregnancy test used a reverse latex agglutination method, so no agglutination meant a positive test. I well remember carrying those black cardboard slides from light to light, peering at those white particles for any sign of clumping. I always felt relief at immediate agglutination.
While this case is isolated -- most providers don’t question laboratory interpretation of serological reactions -- I wonder why it happened. Well, let’s see: after performing agglutination tests in her clinical rotation she believed they were all the same; she believed our lab had a reputation for incompetence; she believed I was incompetent. Maybe, she just believed her patient was pregnant. I’ll never know.
Fortunately, disbelief is sporadic: an outpatient 120 sodium; an outpatient 25 random glucose; an elevated hemoglobin following a transfusion; a blood type discrepancy. And, of course, microscopic results from urine casts to band counts to cerebrospinal fluid Gram stains. I don’t take it personally, since labs are not infallible.
Some of this is healthy skepticism. Physicians often order lab testing to confirm a suspicion, or they want to be sure they understand a finding. The “I got burned once” bias occurs. City docs sometimes don’t believe small labs. And some gripe without calling, I’m sure. I don’t take it personally, since doctors are not infallible, either.
In my story, the PA argued the test was positive until I finally gave her a package insert and went back to work. She huffed off. Perhaps, she took my suggestion and ordered a repeat test on a first morning void, but I doubt it. She believed what she believed, and my results weren’t on the list. Ah, well.
But is it a good idea to have a policy to address complaints of disbelief? I wonder. In our business, belief is everything.