There have been situations in my career when I wish I knew less and when I wish I knew more about pathology and laboratory medicine. Typically both of those emotions arise when a personal situation collides with my professional world.
A very close friend of mine just had a miscarriage when she was 13 weeks pregnant. During this sad and emotional time she was faced with a tough decision. Did she want to have the fetal tissue tested after her D&C for chromosomal abnormalities? Her OB said the fetal tissue would be sent to pathology either way but further testing could possibly answer the question as to “why” she miscarried. The word “pathology” stuck with my friend and since she knows what I do she called me for advice and for my opinion on whether she should have the testing done.
I was deeply concerned and sad for my friend. Although I wanted to help her I knew there was no way I could (or should) answer this for her- it had to be her decision. But one thing that was obvious was my friend needed more information and a medical professional she could talk to.
I believe that medical professional should of been a geneticist, pathologist, or someone affiliated with the lab. Lab tests are often just ordered, or if presented to the patients as an option, the ordering physician typically do not know enough of the facts on the test to answer questions beyond generalities. In the case of my friend I think the answers to the following questions may of helped her:
- What exactly is cytogenetic testing and what exactly will the test tell me?
- How is the test preformed?
- Who does the testing? Is it done in a lab here at the hospital or sent out?
- Who reads/diagnoses the test results?
- How accurate are the results? Are false positives or inaccurate results possible? If so, how possible?
- Does insurance cover this test?
I am going to guess her OB would not have known the answer to these questions, but someone in the lab would or should! The day before my friends D&C she received a telephone call from her OB and an Anesthesiologist to prepare her for the procedure. What if someone from the lab had called too to go over the pathology and testing options? Would that have helped? I’m guessing so!
We need to transform the model of care in the lab to include a proactive approach to diagnosis and testing rather than just reactive. From a business perspective I’m guessing the lab would prefer patients to order cytogenetic testing. To increase orders for the right lab tests and to decrease the blind useless ordering of other tests, labs and their physicians must step up!
In the end my friend decided against the cytogenetic testing. Her lack of understanding of the tests and fear of a gigantic bill when insurance denied the claim caused her to decline the testing. Yet the tissue was still sent to pathology. So somewhere in some lab there are glass slides with fetal tissue from my friends baby. Will she ever know the pathologists findings? Probably not, but she should.
