Discussing lab/test results....

Piglet08 · Aug 2, 2012

I would have done that, too.

classicdame, MSN, EdD · Aug 2, 2012

check with facility policy. It is easy to get in way over your head because the patient may ask questions and you tell them something the MD needs to explain. If you give info be sure to say that you cannot interpret the data, just report it.

nurseprnRN, BSN, RN · Aug 2, 2012

i absolutely hate it when i hear a nurse say, "you'll have to ask the doctor about that." it's such a cop-out. you can't convince me that only a physician can interpret a lab test or a radiology report.

first, it makes the patient even more convinced that nurses don't know much and physicians are the most important part of health care. second, it bespeaks a lack of confidence in one's own knowledge.

third, it makes the patient wait anxiously, perhaps until tomorrow, before he can consult the oracle of the gods, um, ah, the physician.

fourth, it makes the patient worry that perhaps it's so bad that you can't bear to tell him.

"the radiologist's reading says that compared to yesterday's xray the pneumonia area is smaller" is something you can say, because it's fact. you can also add, at this point, "all that hard work we did with the coughing and deep breathing is paying off for you! keep it up!"

conversely, "the radiologist's reading says the pneumonia area is a little larger today. this is why you are feeling even more short of breath. i know you don't enjoy that coughing exercise, but not doing it will contribute to making things worse, and so does lying in just one position. how about we get you up in the chair and do those deep breaths now?"

as for lab results, your patient knows, or needs to know, about coags, so it's perfectly appropriate to say, "your ptt is a little longer than the target, so i'm going to decrease your heparin drip."

"your blood glucose is 150, so here's your sliding scale regular insulin. i see your a1c is pretty high. do you know what that is and what it tells us? let's talk about your diabetes control at home."

this demonstrates that you are the expert and active partner in care that you really are.

caliotter3 · Aug 2, 2012

I find it exasperating when even the doctor puts off explaining test results. Why bother with tests if you aren't going to do anything with the results or even talk about it with the patient? This just happened to me recently. Thinking I need to request a copy of the records so I can read the information for myself. What a runaround.

Dixon, future NP · Aug 2, 2012

I absolutely hate it when I hear a nurse say, "You'll have to ask the doctor about that." It's such a cop-out. You can't convince me that only a physician can interpret a lab test or a radiology report.
First, it makes the patient even more convinced that nurses don't know much and physicians are the most important part of health care. Second, it bespeaks a lack of confidence in one's own knowledge.
Third, it makes the patient wait anxiously, perhaps until tomorrow, before he can consult the Oracle of the Gods, um, ah, the physician.
Fourth, it makes the patient worry that perhaps it's so bad that you can't bear to tell him.
"The radiologist's reading says that compared to yesterday's xray the pneumonia area is smaller" is something you can say, because it's fact. You can also add, at this point, "All that hard work we did with the coughing and deep breathing is paying off for you! Keep it up!"
Conversely, "The radiologist's reading says the pneumonia area is a little larger today. This is why you are feeling even more short of breath. I know you don't enjoy that coughing exercise, but not doing it will contribute to making things worse, and so does lying in just one position. How about we get you up in the chair and do those deep breaths now?"
As for lab results, your patient knows, or needs to know, about coags, so it's perfectly appropriate to say, "Your PTT is a little longer than the target, so I'm going to decrease your heparin drip."
"Your blood glucose is 150, so here's your sliding scale regular insulin. I see your A1c is pretty high. Do you know what that is and what it tells us? Let's talk about your diabetes control at home."
This demonstrates that you are the expert and active partner in care that you really are.

Perfectly said! I aspire to be a Nurse like you who keeps his/her patients informed and uses the knowledge he/she learned in NS and on the job. I begin the RN program this month and I am going to do my best to absorb all I need to know to be a great Nurse and one day NP.

Aurora77 · Aug 2, 2012

I couldn't agree more with GrnTea. Several years ago (before I was a nurse), I had a large, complex cyst on my liver. Before we knew what was going on, I had an ultrasound. The tech basically asked me "Are you sure you're not having any pain?" The implication was very clear--there was something there that made her think I should be hurting. At the end, she used the "I can't interpret these things" excuse. It was crazy and really caused me more worry than had she owned up to the fact that she saw something.

I've taken that to heart. Most of our docs are great about explaining what labs/radiology reports mean to patients so most of them are fairly savvy. I have no problem letting people know about blood counts, electrolyte results and telling them what they mean. On my floor, we generally have the same patients for several days in a row, so I feel like it's only appropriate to address their progress each day.

Anna Flaxis, BSN, RN · Aug 2, 2012

In a nutshell: It depends.

I've had patients present with pneumonia like symptoms, thinking they had pneumonia, only it turned out they had lung cancer. Or patients with chest pain thinking they're having an MI who turned out to have pancreatitis. Or five day headache thinking they have a migraine, turn out to have a bleed. When they ask me about their imaging results, I say "The doctor will have to talk to you about that".

I think in your case, since it was already a known diagnosis, and there was nothing out of the ordinary on the x-ray, it's just fine that you read them the radiologist's impression.

As far as lab results, I think if, for instance, they're a renal patient and want to know their creatinine, or they're on warfarin and want to know their INR, it's fine to tell them. But, if you're interpreting those lab results and giving them a *diagnosis*, then that is the physician's job to do.