Thursday, August 14, 2008

By Secretary or By Professional Report

A recent study caught my eye. Done by multiple centers.....
from the Division of Laboratory Systems,* Centers for Disease Control and Prevention, Atlanta, Georgia; the Wadsworth Center, New York State Department of Health, Albany, New York; the Albert Einstein College of Medicine, New York, New York; ARUP Laboratories and the University of Utah, Salt Lake City, Utah; the Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; San Ramon Valley Primary Care, San Ramon, California; the Genetic Services Laboratory,** Sequenom Incorporated, San Diego, California; and the Department of Human Genetics, Mount Sinai School of Medicine, New York, New York.

What did they investigate? genetic tests were orderded and how results were given. What really got my goat was the results.

First as a preface....the AMA in June put out a statement against DTC genetic testing Resolution 502, A-04. D-480.987 in case you want to check it out. This statement says:

Our AMA: (1) recommends that states restrict the performance of clinical and laboratory genetic testing to individuals under the personal supervision of a qualified health care professional......

Also in the AMA policy manual is E-2.131.....

Physicians who order genetic tests should have adequate knowledge to interpret information for patients. In the absence of adequate expertise in pre-test and post-test counseling, a physician should refer the patient to an appropriate specialist....

So with that backdrop I give you the study "Ordering Molecular Genetic Tests and Reporting Results. Practices in Laboratory and Clinical Settings."

To understand better the contributing factors to such compromised care, we investigated both pre- and postanalytical processes using cystic fibrosis mutation analysis as our model.

Ok this will be great! CF testing. When was the last time the OB went over pre and post test counselling for carrier status???? I can't wait to see the results...

1. We found that although the majority of test requisition forms requested patient/family information that was necessary for the proper interpretation of test results, in many cases, these data were not provided by the individuals filling out the forms.

2. We found instances in which result reports for diagnostic testing described individuals as carriers where only a single mutation was found with no comment pertaining to a diagnosis of cystic fibrosis.

3. Remarkably, a pilot survey of obstetrician-gynecologists revealed that office staff, including secretaries, often helped order genetic tests and reported test results to patients, raising questions about what efforts are undertaken to ensure personnel competency.

If you have any question as to why OB/Gyns get sued more often than anyone else.....look no further than the results of this study!

The Sherpa Says: The real pickle is this. The American College of Obstetrics and Gynecology recommends that every pregnant woman get "screened" for cystic fibrosis mutations. So the OBs are forced to do this testing.....oh wait, no they aren't. They could actually refer patients. Or even better, they could hire a geneticist. But why do that when they could just have their secretary do that work? Scary stuff!!! This makes DTC look pretty warm and fuzzy.


Hercules said...

it's not just the OB/GYNs -- all the physicians I know do the same thing -- they skip the family history that goes with the genetic test, and delegate test interpretation to their admins, which saves a lot of time and effort... but as long as the Feds and State Depts of Health insist on testing via a physician practice, everyone is happy, because that's where the insurance coverage is based, and who can argue with that?
(glad you are feeling better.....)

Steve Murphy MD said...

Until the physicians get sued for someone giving the wrong test results. This is a very common thing. My guess, is that the more savvy patients and lawyers get, the more likely we are to see a bigger set of lawsuits on this. Shame on the physician who delegates this to someone who has even less training in genetics than them!!

I wish they would just hire someone with the training. I know a ton of CGCs that could use a job outside of writing grants ;)


Anonymous said...

I volunteered at a OB/GYN department where every female that was over a certain age had to have genetic counseling done.

I also volunteered at a medical genetics department where there were three genetic counselors and two clinical geneticists. The genetic tests were entered by the medical assistant (the medical assistant worked with a department assistant--not at the front desk). They did this to free up time so the counselor and geneticist could focus more on patient time and diagnosis.

Steve Murphy MD said...

There is a big difference between getting insurance authorization and gviing test results. This survey indicated that the secretaries were giving test results over the phone.......not exactly what "trained healthcare professional" connotates.

Some OB practices are very good at identifying risk....others still don't know what Lynch Syndrome is a wide variety.....we have to find a way to reduce that.


Anonymous said...

I thought you would like this blog posting. sometimes the best reading a doctor can do is reading what the patients think.

Steph said...

The ACOG mandate for CF testing came out while I was getting my genetic counseling degree. I gave quite a few counseling session to pregnant women regarding CF testing. Unfort6unatley that was in a high-risk OB office where the patients were already undergoing some form of prenatal screening through our office. I know at the hospital medical clinics, no counselor was available to do the CF counseling. It was a big mess.

Then, in 2006 when I was pregnant I actually requested the CF carrier test for myself and my OB did not even talk to me about the test at all. She just wrote a script to get my blood drawn. No family history was taken, no explanation was given about what the test was screening for or what it meant if I was a carrier. I was very disappointed with how it was handled.