Monday, November 9, 2009

A Bit O' the Ugly

We have a customer who comes in every few weeks -- nice squeaky-voiced little elderly lady, early 80's, who seems really sweet. She refills a prescription which is used for possible Alzheimer's symptoms or at least early signs of confusion/dementia, but she comes in unassisted and neatly writes a big fat check for this medication.

The other day I heard her asking the technician about some lab results she had been mailed from her doctor's office. I went over to see if I could help with the question and looked at the letter she had in her hand. There was a serum creatinine result and also an estimated GFR, so these were obviously kidney function tests. There were two results for the GFR, however, and one was labelled "Afr-Amer" or something like that. I don't deal with this a whole lot, but I told her I thought it was because a correction factor is applied if the person is African-American -- there's a different 'normal' range, and the lab printouts show this as a matter of routine so the correct result can be applied. These printouts can be confusing for anyone to read, no doubt, and I figured she just didn't know what the heck any of it meant.

Well, I quickly realized it wasn't the numbers that she was questioning, it was the "Afr-Amer" part. This little mouse of a lady, always pleasant small talk, usually in and out in a minute or two, got kind of upset. She got this hard edge to her voice I never heard before, and said "Why is THAT on there? Are those even my results? I just don't think THAT should be on there!" and repeated these comments several times. We finally offered to call the lab and have them explain it to her. "YES, I would like to do that," she said firmly.

Wow. After she left we all looked at each other, kind of taken aback. One of the techs ventured a comment about "people from a certain era and age group" . It was just weird to see this little bit of ugliness coming out of this (presumed) nice little old lady.

Just another interesting observation from another day at the pharmacy.


Anonymous said...

Much too bad the woman was mailed these results. She obviously did not understand them, and why would she? Why didn't the doctor send her an interpretation of the results?

I work hospitals and one of the facilities uses this format for reporting a basic electrolyte panel and then 'handily' lists CrCl based on numbers from the lab draw, not incorporating height or weight or body surface area to give a falsely high number which might inaccurately suggest better kidney function than might be a problem for physicians to base dosing especially in obese patients or underlying damage due to diabetes, or elevated renin levels. The disclaimer about being African American is a way to avoid being sued for these patients. The hospital that uses it has no African-American patients so the lab report seems useful to that facility, but is slightly irritating, though pharmacists are required to check every single dose of every drug there. (Why was the tech talking with the lady about them, anyway?)

Frantic Pharmacist said...

The technician wasn't trying to address her question, I just overheard her asking it and knew the tech would call me over anyway. I agree with you though, they shouldn't mail out a sheet full of lab results without a simple, plain-English explanation...

Grumpy, M.D. said...


Shouldn't have mailed it to her.

World is full of closet racism, and usually the person involved comically doesn't believe they are.

Grumpy, M.D. said...

Love the Lucy pics, saw you changed it.

I always think of the scene in "Rat Race" when Cuba Gooding Jr. hijacks a bus full of I Love Lucy Fans.