All The Other Labs Do It
We report an estimated GFR using the MDRD (Modification of Diet in Renal Disease) equation. Sometime last year we stopped reporting the value in patients over seventy, because it hasn’t been validated for that subset of patients. It can still be useful, but it can also be misleading. Curious providers can use online calculators, preferable to reporting a questionable value.
And while our information system is able to automatically add patient age into a calculation, it can’t access weight or any other parameter for other calculations such as the Cockcroft-Gault that modify an estimate for BMI.
That can be difficult to explain. I received a telephone complaint from a nurse at a nephrology clinic that we didn’t report an estimated GFR on a patient greater than 70. I explained why, but she was adamant.
“I don’t understand why you don’t report it,” she said. “All the other labs do it.”
This is more than a simple argumentum ad populum fallacy. Despite being given a logical reason for suppressing the number, she insisted over and over that “other labs” provide the result. Why not us? I can imagine her thoughts as she repeated herself: your lab is smaller and not as good as the others; you aren’t as current as bigger labs; you’ve created a general rule for a special circumstance e.g. a patient with little muscle mass over 70. Perhaps. We just adopted a different policy based on recommendations.
I don’t think her bias is condescending. I’ve heard too many variations of this “bigger is better” argument over the years to take it personally. It’s a peculiar blind spot of larger organizations. One could also say, “Smaller is faster,” I suppose. In smaller labs techs know their patients and customers. It’s easier to be a generalist in a smaller lab. And so on.
Still I’ll bet this nurse won’t ask the other labs why they “all” do it when we don’t. Our deviation is a source of irritation and a customer service issue, despite a report comment and my explanation for no result. And you know? She’s right.
NEXT: Eat Breakfast, Work Smarter