what do you say when a pt or their family wants you to interprete a lab results/tests and you dont know how to interpret the result? anybody been in that situation.
I had a pt. wanting to know a recent CT scan result. As I was reading the interpretation, there were at least 5 diff things listed although one was easy in simple terms describing that there was no hemorrhage but the others were totally out of knowledge, describing growth of certain nodules and all. And most awkwardly, I did not know why the CT was done in the first thing as nothing was mentioned in the Physician Notes.
I actually have a "canned" response for this situation because it happens quite often.
If a patient asks and is insistent, I say to the patient, "I'd love to tell you what it says, but I don't really know how to read them. If I could, I'd be getting paid a heck of a lot more money!"
The truth is I often do understand what the tests mean, and I've got a pretty good handle on most of the diagnostics at this point in my career. MRIs, CTs, XRays...I'm not one to give a patient bad news though, I leave that for the doc to handle.
Thank you for your honest response; however, I feel that your reply is demeaning to the nursing profession. Your statement is easily interpreted as "I don't know anything because I'm just the nurse". Rather than say "I'd love to tell you what it says, but I don't really know how to read them. If I could, I'd be getting paid a heck of a lot more money!", why not try "The results aren't back yet, but when they are I'll let your doctor know so they can dicuss them with you."
We're not stupid; we did go to school and they do teach us to read lab results to a certain extent; we just don't diagnose these results. Its expected of us to be able to anticipate the problem and act accordingly - for example, if someone's Hgb is very low, we know they will most likely need a transfusion and we need to rely on our skills and training to initiate the next step instead of waiting around for the doctor "because interpreting lab results isn't our job."
Lets say that you received lab results on a patient who is hypokalemic (compared to their last labs), and you go ahead and administer their morning digoxin. If the patient became dig toxic and decided to sue, what would you say to the jury? Would "I don't know how to read labs, and if I could I'd be getting more money" be acceptable? (I know this scenario is far-fetched, but I'm just trying to make a point)
Lets all stop pretending to be stupid. Its one thing to see that a patient has a low Hgb and then to tell them that "you are dying, you have a GI bleed". But its completely different to say "your labs are coming back, and I noticed that your Hgb is a little low - has this happened before?"
If I see that someone's Hgb is low in the ED, I immediately let the doc know and I head straight for the patient's room to start another line, anticipating a blood transfusion. It would be negligent for me to delay care just so the doc can have their dose of ego-boost for the day.
If I see that someone's Hgb is low in the ED, I immediately let the doc know and I head straight for the patient's room to start another line, anticipating a blood transfusion. It would be negligent for me to delay care just so the doc can have their dose of ego-boost for the day.
I don't interpret lab/imaging tests ordered by consultant physicians. Not because I can't do it (actually, I can't always do it) but because when folks order tests, they do it for specific reasons and I recognize that I'm not always privy to those reasons.
Similarly, when my service is the consultant, nothing is more annoying than the primary doc "interpreting" studies I ordered incorrectly. For examply, I order an xray for a suspected ACL rupture, primary doc sees no obvious fracture, tells the patient their knee looks okay. I see a Segund sign, tell the patient they need an operation, and next thing you know I'm getting yelled at by some poor dude who just got told he was fine 10 minutes ago.
I've always been told you can tell the patient whatever you want, but you better be right . . .
If a patient asks and is insistent, I say to the patient, "I'd love to tell you what it says, but I don't really know how to read them. If I could, I'd be getting paid a heck of a lot more money!"
...
"But, for what it's worth, AND I'M NOT A DOCTOR SO I DONT REALLY KNOW WHAT IM TALKING ABOUT HERE, IM JUST GOING FROM EXPERIENCE. I'd say you're going to be okay!"
If the patient has already discussed the lab with the doc, and just wants clarification, fine -- as in, "yes ma'am, when he said your cardiac enzymes were fine, that came from the blood test, not the ECG." Other than that, the answer I give is, "I'm sorry, ma'am, the lab releases the results to the doc first, he'll have to discuss that with you."
I've had 2 patients in the last month who came in for something relatively simple -- a lap chole and an ulcer clip -- where xrays showed tumors that were incidental findings (both judged malignant on the xray report, and both turned out malignant). That was a rough night. The guy's all happy because he's feeling better, talking about going to the amusement park with his grandkids, and I'm thinking, "the only place you're going is to the oncologist, and you don't know yet."
i was always taught that interpreting lab results, etc was considered medicine and not nursing. so i always say "that's something that the doctor will explain".
No, only when people bug me about their test results. That being said, I say it jokingly and not seriously...people realize that...if I was ever your nurse you'd soon realize that I try to inject a lot of humor into my practice. I don't go around telling knock knock jokes, but the last thing someone wants when they're sick is some stonefaced nurse ratchet. It's a good allaround stress reliever for my patients as well as myself. Try it sometime.
I am so glad someone posted this on here. I was ALWAYS under the impression that the doctor had to report lab results numbers and all. I am just wondering what everyone thinks about that? Obviously I will call any resluts to the doctor, but if they do not tell the patient the results when they come in to see the patient, then it is not my responsibility to do so. Is that correct?
I had a patients daughter call me over the phone recently, she was a nurse living out of state and although she was POA the patient had not signed a release of information consent and there had been no password set up. I also was under the impression I was not allowed to give out these results, so I respectfully gave her the exchange number for the physician. Then the patient got mad at me and asked me what his INR was, which is what she wanted to know. Next, the doctor who was on call was not his regular doctor and did not tell him these results, I told him I am not allowed to give out those results it is a physician responsibility.
Nurses aren't expected to be able to read a CT, but we are expected to understand a radiologist's interpretation of the CT. More than likely at least where I work, if the RN doesn't inform the patient of test results they will never know what they were.
Saying it's "out of our scope" to understand test results is embarrassing.
We all could discuss HIPAA, hospital policies, scope of practice until the cows come home.
Nurse Darcy, If the patient had some basic level of understanding about his INR level, why it was being tested, what the meant, let him know the results and ask him if it was okay to tell his daughter. (I would probably have even told the daughter if for some reason I couldn't easily ask the father for permission!)
USCSTU4lfe, you would never tell a patient a lab result??? Assess your patients level of knowledge, they may know more about their illness than you do. Use common sense. I hope it to too obvious to need saying but tell diabetics their glucose levels and how much insulin you are giving them. There are hundreds of other examples of when I would give my patient "medical" information. Assess and trust your level of knowledge and the patients.
November 17. I completely understand your joking sense of humor. I think it is as effective a way as any to let the patient and family understand you are not being rude to not tell them the results of a test. Or if you do tell them you are reminding them that their doctor may have more knowledge of their disease process and his interpretation may be a little different from what you tell them.
I sometimes tell my patients, If I were someone you met on the street and had no nursing/medical knowledge this is was I think or would do, but you have to talk to your doctor.
seriousnurse
18 Posts
thanks to everybody, great suggestions. i tend to stay within my scope of practice.