Demystifying Down: a poem by Dr. Bharati Dalal, MD

Demystifying Down
                               
When I handed over to a patient, her triple marker report,
that her foetus had a very high risk for the syndrome Down,
& that she will have to, her child abort,
she tearfully, completely broke down !

"But how can the changes in my blood chemistry,
affect the chromosomes of my child ?
Please narrate to me details of the history
of discovery of this syndrome most unkind !"

I replied that it was not her chemistry,
that had caused her foetus such misery profound;
But it was truly a Mother Nature's mystery,
and that matters were exactly the other way round.

The shock and grief written all over her face,
brought tears brimming into my eyes,
I thought I should show some pity and grace,
to stop her from taking more sighs and cries !

I explained to her the normal karyotpe,
and how a meiotic non-dysjunction
of the sperm or ovum, gamete cell-type,
had caused the trisomy twenty-one.

For a long time she stared at me aghast,
then finally broke her silence,
" I am thrilled at your knowledge so deep and vast,
and your keen interest in the Medical Science !

Thanks to the untiring efforts of people like you,
the world is becoming a safer and better place to live;
I accept my fate with all respects due,
to GOD, who has decided what to me, give ! "

Dr. Bharati Dalal, MD

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Demystifying Pathology Laboratories,
is the hardest aspect of a PATHOLOGIST'S role;
Sometimes, to make laymen aware about diagnosis of diseases,
is like fitting a square peg in a round hole !

To know the significance of all laboratory investigations is easy,
and to clinically co-relate them, a mere child's play;
To keep pace with technologic advances is breezy,
and working with smiling affable technicians, makes your day !

But to explain what is urea, bilirubin or cholesterol, to patients
ignorant of the SCIENCE of function of kidney, liver or heart,
is a tough task taxing your time and patience,
and of testing your iimbic system in vivo, an ART !

Those who know EVERYTHING about trekking the HIMALAYA RANGES,
are ignorant that 5% of NORMAL population have results mildly ABNORMAL;
They know NOTHING about the limitations of REFERENCE RANGES;
and that some of the DISEASED population can have their results NORMAL !

To handle such grouchy griping grumpy persons, somehow,

has never been my cup of tea;
At the fag end of my career now
I have voiced my thoughts in public openly !

Dr. Bharati Dalal, MD

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Out of range test results!! What does this mean?

The most often asked question in my years of working as a pathologist has been; “My lab tests are a little above or below the given range?"

A minimal deviation from the given reference range raises the anxiety levels of most patients. This is followed by many more questions. Is this a cause for concern? Do I have some dreadful disease?

I would like to address this issue and hope it helps someone alleviate his or her anxiety.

Reference Range for a test, also referred to in lay terms as “normal range” is an average of values for a specific test. Testing a number of healthy individuals who do not have the disease which the specific test is intended to diagnose, enables laboratories to set a reference range for that test. The range also takes into account the age, gender, location, ethnicity etc.

• Since this is an average, there will always be people who may fall outside the range with minimum deviation.
• If such an individual is healthy, has no signs and symptoms correlating to the minimally “out of range” values, there is no cause for concern.
• However, be cautioned, this conclusion has to be made by a physician in context of your overall physical examination and clinical history.

If a physician orders a repeat test, it is important to have the test done from the same laboratory, provided it is an accredited laboratory with history of quality work. Why is this important?

• Reference ranges may vary between laboratories.
• The labs may serve different sets of population and ethnicities, may use varying test methodology or equipment leading to variations in reference ranges.
• So for follow up of a particular test, it’s always best to stick to one specific laboratory. This allows the physician to compare the results without having to deal with all the variables. It’s like comparing apples to apples and oranges to oranges.
• These recommendations presume that the laboratory maintains adequate quality control and quality assurance.

So next time you have a set of lab results with values minimally outside the reference range, before pushing the panic button, please remember:

• If you fall out of range, it does not automatically indicate you have a disease.
• Rarely there may be other causes – misidentified sample, sample not stored properly, collected in the wrong tube etc.
• The laboratories take extreme precautions to prevent such mishaps.
• A single test parameter is not adequate to make any diagnosis. It’s usually a panel of tests, which is diagnostic.
• If you are tested over a period of time, as a routine check up or for chronic disorders, your individual test results are a better reference range for you, allowing your doctor to asses your disease risk or follow up.
• All lab tests are dynamic values and will vary every time the test is performed. As long as they are within range or correlate with your medical status a physician will be able to provide a meaningful interpretation.

 Neha Dahiya MD

If you have any questions, please feel free to leave a comment and I will try to answer as soon as possible. Thank you.

Pathology labs need better understanding.... Perception Versus Reality...

Pathology labs are a distinct part of healthcare fabric. Their role, is often central to information on wellness and disease diagnosis or management. Over years, practice of pathology and utilisation of its services has seen considerable change, largely owing to advances in technology and better understanding of basic health science.

Over two decades of serving patients from a standalone laboratory in a busy cosmopolitan city in India, I get a ring side view of perception of people both inside and outside a medical lab. Sometimes, I get the feeling there is a disconnect between the two, though it may only be my personal view.

Inside the lab, staff handle technology and human samples in the same breath, not realising the different nature of each of them. Outside of the lab there is always a doubt in the mind of patients on the results received. Both these views need to change and it is necessary to happen at the earliest. There is no doubt that patients have come to suspect lab results as they have experienced errors in service, giving them an exaggerated "feel" of errors. Patients who have experienced an error in lab result would continue to suspect every result that is provided by a diligent lab or any other lab.

Question then is "Shouldn't labs do something about it" ? 
This question is common to both sides of this mind created distinct entities of "Labs" and "Patients". When we are open to hear and see the view points of people using lab services and those providing lab services, our horizon widens.

With the above in mind, I invite views from human beings (that is what we are first...!) in the labs as well as those using services of labs.

Dr. Sujay Prasad
Anand Diagnostic Laboratory

Bangalore

When Do you need to consult with a Pathologist?

After over 2 decades in the field of Diagnostic Medicine I feel that a  patient should be able to really get answers to his or her questions regarding the report or the final product that is with him or her.

I agree that the reports need to be clinically correlated and dealt with but a proper understanding of the test, its limitations, the different reference  ranges ,  the analytical range of testing and the clinical reference range with each test kit and analyser are of prime importance

One should be able to address this.

I would like to hear back from the general public and fellow doctors on what they think about this

Regards
Dr Gandhi