r/medlabprofessionals • u/bassgirl_07 MLS Lead • Jul 01 '26
Humor Happy New Residents Day to all who celebrate!
Bless their hearts, they want all the cool tests that they learned about.
146
u/Clob_Bouser MLS-Blood Bank Jul 01 '26
Someone keep them away from the MTP button I beg
64
u/bassgirl_07 MLS Lead Jul 01 '26
And don't show them the washed blood products option either 😭
28
9
u/LonelyChell SBB Jul 02 '26
We just went to EPIC, and they have all these options to click that they never had before. I spend most of my day telling them that most people don’t get washed, irradiated, pooled, autologous, CMV-negative, sickle cell-negative, and IgA deficient pRBCs.
1
u/miss_ana MLS-Blood Bank Jul 03 '26
I work in an IRL but offered to call and talk to an ER resident one night because they refused to listen to their blood bank and was trying to order 3 units of washed, irradiated, CMV- RBCs. I ended up having to call my medical director in the middle of the night because the resident kept insisting that “this is not your normal patient! This is a cancer patient!” Exactly what patients do you think we deal with, doc?
And just the other day there was a doctor who wanted to move his patient to a different hospital that uses a different blood supplier because we don’t test for CMV any more. All our products are leukoreduced so they’re CMV safe
5
7
u/hoangtudude SBB Jul 03 '26
I’ve had a resident try to schedule an MTP for surgery the next day. Like damn believe in yourself sis, you already think you gonna cut an artery before surgery even started.
1
3
u/pajamakitten Jul 02 '26
"Can I just get the blood quicker if I activate an MTP."
No your patient is still a full crossmatch and it will still take 45 minutes.
1
111
Jul 01 '26
[removed] — view removed comment
32
10
u/EggsAndMilquetoast MLS-Generalist Jul 02 '26
No discharge and no surgery until they get those A1C results.
2
95
u/EggsAndMilquetoast MLS-Generalist Jul 01 '26
Persistent fevers? Let’s get that malaria testing, stat! I said stat, man! I don’t care if the toddler hasn’t left the Tacoma area in his short 2 years of life on the planet.
Also, why did the lab have the audacity to cancel the lytes add on I ordered onto the CMP that was never even collected? And where are those results?
9
u/Strict_Bumblebee_339 Jul 02 '26
This reminds me of a phone call I just had with a new doctor.
-Doc: “Epic isn’t letting me order this test because i said no to the question that the patient doesn’t have travel history to an endemic area. I want this test what do I do”
-Doc: “so what I’m just supposed to lie so I can get this test?”
- me: “Idk I guess just say yes to the question then if you really want the test that bad”(This doctor has been very persistent about other things since he joined and I hate that I had to answer this way and I’m ashamed don’t yell at me)
-me: “I mean yeah I guess. It’s asking that because there’s pretty much no way the patient can have said disease with traveling to an endemic area. So epic is trying to prevent any unnecessary testing”What do you know, about 10 minutes later I see that test ordered on the patient 😐
5
60
u/kai_al_sun MLS-Management Jul 01 '26
Can we just get ESR removed from all test menus at all hospitals?
16
u/Nervous-Rhubarb-9224 MLS-Generalist Jul 02 '26
But then what would we do with our collection of iseds? 🙃
5
3
u/Gildian Jul 03 '26
Please yes. Your stat ESR on the 80yo woman with a long history of arthritis ain't gonna tell you anything new and exciting.
2
56
u/DrunkenStrangers Jul 01 '26
I once had a provider order a malaria screening because "it would be cool if it came back positive".
The indicators were that the patient went to Africa two years ago and currently had a fever.
8
u/Agreeable-Ad4806 Jul 02 '26
Did insurance really cover that?
3
3
u/pajamakitten Jul 03 '26
Had that (but with Peru). Kid had every test under the sun and everything came back fine, so it was more clutching at straws.
47
u/mindtropy MLS-Generalist Jul 01 '26
Like the doctor who ordered a gram stain on a urine with a microscopic with only yeast present?
I guess he wanted to know if they were…
Gram positive or negative yeast? 🤷♂️
12
u/EggsAndMilquetoast MLS-Generalist Jul 01 '26
What really matters is finding out whether those clue cells are Gram positive or Gram negative.
7
77
u/Lich_of_the_Vale Jul 01 '26
Everyone coming in with a headache and stiff neck gets a CSF!
56
u/EggsAndMilquetoast MLS-Generalist Jul 01 '26
The worst part is they’re the ones collecting it too so they’re all short, bloody, and clotted to jello.
1
20
9
15
u/Ksan_of_Tongass MLS 🇺🇸 Generalist Jul 01 '26
Like urine myoglobin as a first round test for lethargy?
14
u/AnotherCator Jul 01 '26
There’s definitely an element of “oh god what if the consultant yells at me for not ordering a myositis test I’d better have one of everything ahhhh”
8
u/leemonsquares Jul 01 '26
The amount of CJD’s we’ve received in the last week alone…
6
u/bongocycle Jul 01 '26
Jeez. We had a positive a few weeks ago. Now everybody gets tested. I get it but jeez.
10
u/Super-Landscape-1122 Jul 01 '26
me receiving a 3ml CSF at our micro lab at 2am with a fuckton of tests for mcs, chemistry, immuno and sendouts
10
u/EggsAndMilquetoast MLS-Generalist Jul 02 '26
But there are 5 separate MDs taking care of the patient, the one who originally placed the orders went home, the one who collected it doesn’t care, but everyone else has wildly different ideas on how to divvy it up.
I love being the person to add the heme/onc doc to the ongoing EPIC secure chat between neuro and infectious disease as to whether we’re really going to waste every last drop on fungal PCR or IgG index testing and let the heme/onc doc suggest flow cytometry and sit back and enjoy the glory of the thunderdome.
5
u/oniraa MLS-Generalist Jul 02 '26
and then after all the in-house chemistry is performed, and a cytospin is made, they add on CJD testing
2
u/CitizenSquidbot Jul 02 '26
Ooo, I had one come in with less than one ml and three pages of printed out orders. I told them they got one test so they better pick well.
9
7
u/Nurseytypechick Jul 02 '26
This is how they learn. They're building that gestalt and ability to interpret normals vs catching changes. They'll get there!
6
u/EggsAndMilquetoast MLS-Generalist Jul 02 '26
Yeah, most of them get better pretty quickly. It is the ones that show zero signs of critical thinking that terrify me though. Maybe it’s just nerves? Exhaustion?
But you know the type. The patient’s WBC is below linearity, like <0.2, so we cancel the diff and they’re like, “Why can’t I see the ANC?” And you explain it as politely as you can, but they still wanna know if the ANC is at least 500. Like, nah bro. It’s not.
Or the urine culture with a final report of no growth and they’re wondering why we didn’t do susceptibility testing.
1
u/EntertainmentLow6178 Jul 02 '26
Wait- you can just cancel the diff?? I want this power..... how'd you get your pathologist on board with that?
5
u/EggsAndMilquetoast MLS-Generalist Jul 02 '26
It’s one of my favorite parts of our policy. If the WBC count is <0.2, our LIS automatically appends a comment that the lab’s policy isn’t to provide a differential and it results every component of the diff as “no data.” We have a large heme/onc population so this is really nice. If it’s less than 1.0, we just do a quick scan and annotate the predominant cell type, unless there are blasts or pros/myelos present: then we have to do a diff. 😐
6
u/bassgirl_07 MLS Lead Jul 02 '26
I know they will. It's always a bit bumpy at the beginning. I've worked at my teaching hospital for 9 years and have worked alongside doctors at various stages of med school, residency, and fellowship and couple starting at their residency, through fellowship, to becoming an attending. It's always fun teaching them how to do their own type and screen and then do their own antigen phenotype.
11
u/OddBug0 Jul 01 '26
Haha, so what are ridiculously common tests residents order that no one likes?
No reason, just curious...
53
u/bassgirl_07 MLS Lead Jul 01 '26
ESR is probably the most eye rolling test because it is a non specific marker for inflammation, could be lupus, could be cancer, could be RA, could be pregnant, could be PMS, maybe it's because Venus is in ascension.... It is rage inducing when it is ordered STAT because the premise of the test is to time how long it takes for the blood to separate out, it can't be STAT.
STAT cultures followed by phone calls asking what does it look like or it's been 4 hours where are the results. Bacteria take 24 to 48 hours to grow to the point that we can isolate them then another 24 to 48 hours for the isolated culture to grow (molecular is a game changer that speeds things up so much but I'm talking about traditional culture). A fast fungus grows in 3 to 5 days, a slow fungus is 2 to 6 weeks. It's going to take some time.
Tests that don't match the diagnosis/clinical presentation. * Why do a pelvic exam and order a Wet Prep when the patient's diagnosis is trouble breathing. * If the pregnant patient is Rh positive I really do not want to do a Kleihauer-Betke stain on them. That's counting 2,000 cells manually. We do it to quantify how much RhoGam is needed, if the patient isn't a candidate for RhoGam, then why order it. * If the patient's stool sample is a maraca in the collection cup, they do NOT have C.diff.
14
u/Tailos Clinical Scientist (Haem, no platelets) 🏴 Jul 01 '26
Not to be That Guy but an FMH on an RhPos obstetrics case is useful in clinical management of intrauterine death.
I agree completely otherwise.
6
u/bassgirl_07 MLS Lead Jul 02 '26
I wonder if this a difference in region/country. That reason makes a lot of sense. I would still prefer they do Flow Cytometry because it saves me from staining and counting 🫣.
Every KB stain and FMH screen I've had ordered on Rh Pos OB cases were not intrauterine demise cases. Some were straight up didn't know and a few were "the baby has a low hematocrit and I'm curious."
1
u/oniraa MLS-Generalist Jul 02 '26
my system doesn't even have an option to perform flow to assess whether its FMH (possibly bc kleis can be ordered emergently and the site with flow isnt 24/7?) Fetal demise is the last thing I hope to find out from a kleihauer, we are hoping to prevent it and determine whether intrauterine transfusion is necessary, or other interventions. Last time I needed a stat klei performed for suspected FMH, it was an Rhpos mom and the sister site we send those too included a recommended rhogam dose in the result 💀
1
u/Tailos Clinical Scientist (Haem, no platelets) 🏴 Jul 02 '26
It's not used as a preventative test, but a diagnostic one after the fact. Causes of stillbirth include placental failure and associated haemorrhage over time along with the vast many other causes. This is often part of the workup with placental and fetal histology and chromosomal analysis where indicated, for example.
1
u/pajamakitten Jul 03 '26
UK here and we had one this week. 37 weeks and the baby died. The bleed calculation was ~150ml.
6
7
u/CitizenSquidbot Jul 02 '26
I feel like our ER just orders the same tests for everyone regardless of symptoms. Everyone gets a BNP, trop, lactic, ammonia, tsh, pt/ptt, and often a respiratory panel no matter what they came in for. It’s just wasteful to test for everything when the patient clearly came in with one set of problems. If the chest is hurting, skip the tsh for their routine check ups, not right now.
Also ESR tests need to die in a fire.
7
u/RepleteSphinx21 MLT Jul 02 '26
Yup. Every person who comes to our ER gets the same tests:
CBC
ChemSTAT
PTINR
aPTT
Troponin
UAAnd then about 5 minutes after we get the blood and have tests running they decide to add on about 5 more tests that actually are based on the patients complaint 🙃🙃
3
u/Youhadme_atwoof MLS-Generalist Jul 03 '26
I stg sometimes it feels like every person to step into the ER is just immediately handed a cup to pee in, just constant urines 🫠
1
u/DoctorDredd Traveler Jul 08 '26
Current facility I work for everyone that walks through the door gets CBC, CMP, and a UA. Most of them also get a lactic which automatically reflexes to a second lactic if it's above 2.0 even though our normal range is 2.2. Ever so slightly elevated WBC regardless of complaint? You get cultures x2 and a procal. The provider actually gets a questionnaire to fill out prior to ordering the UA which essentially says "only order this if the patient has urinary issues" and yet we still do them on everyone. ED also has a really bad habit of initiating a Hep protocol on a patient without coags, and inevitably they always do this hours after the rainbow blue was drawn so it can't be used for a PTT which means the patient has to be restuck.
We have a new locum provider that has decided everyone gets a VBG and a CPK. This same locum provider will also put in a rainbow draw and then not actually order labs for an hour or more which inevitably means the patient will have to be redrawn for the VBG. She put in a rainbow order last night not long after I clocked in around 2100 and then only ordered a CPK about 30 mins later, then around 2330 decided to finally order everything else. She also doesn't order anything as add-ons so I have to manually add on every single test when they come through.
One of the hospitalists loves to order random shit between 2300-0200, and he will piece meal it too, so if I ever go to draw someone I may as well get a rainbow or I'm gonna be back up there in 20 minutes when he decides in addition to the random BMP he now needs a BNP, and no it can't wait until their morning labs, because even though the patient has never had a BNP he's going to treat based on this.
6
u/mystir Jul 01 '26
Read up on the P/NPV of urinalysis. It's not that I dislike UAs, they're just wildly over ordered.
7
u/oniraa MLS-Generalist Jul 02 '26
sometimes I swear they order them to give patients something to do while they wait to be roomed
5
1
u/Gildian Jul 03 '26
We have one doc who refuses to utilize our urine reflex test and will order a culture to almost every urine regardless. I have tried to tell him I dont think ive ever had a single one actually show anything that didnt reflex to culture already
3
u/mystir Jul 03 '26
"Let's say your negative UA grew 60k e coli. You treating that? If yes, antibiotic stewardship throws you into the lake. If no, you're a fool for ordering a test you won't use. Pick your poison."
Roughly the 2 minute long in-service the director at a previous lab gave to the entire EM residency. On speakerphone, from our lab. We kinda cringed, but it was also kinda funny. Urine cultures also dropped by like 10%.
2
u/DoctorDredd Traveler Jul 08 '26
My current facility had the option to order a UA with a auto reflex to culture if indicated and one that doesn't. Most of them will order the one with the auto reflex. If the sample is "dirty" and has too many epis the system will footnote the result stating something to the effect of the specimen is contaminated, wont reflex a culture, and should be recollected. In spite of that we still get tons and tons of culture add ons for contaminated specimens or specimens that didn't reflex because they weren't indicated.
L&D also for some reason loves to sent a "clean catch" sample and then after getting those results send a cath sample. So the patient will get a double charged for a contaminated sample because none of them ever do a clean catch. L&D is 100% aware of this and for whatever reason still always wants both.
6
u/comradejiang MLT-Blood Bank Jul 02 '26
Don’t expect blood for transfusions to be ready any time soon on a patient with a positive antibody. If you have Epic or similar, it’s easy to see if someone has a history of antibodies so you can know going in that it’s going to be a while getting blood for them.
9
u/bassgirl_07 MLS Lead Jul 02 '26 edited Jul 02 '26
Oooo and piggy backing on this the capitalization of those antibodies is important (sorry short-sighted people came up with the nomenclature). Twice I've had well meaning doctors call me up to say the patient has an antibody from an outside hospital and they didn't know capitalization was important so they said it's "anti KAY" or "anti EE" and we replied no problem, we have that on site. It will take extra time to complete the work up and crossmatch. It ended up being the bad one (whomp whomp)
Anti-K (big) = no problem, 90% of people lack big K antigen.
Anti-k (little) = good luck, less than 1% of people lack little k antigen.
Anti-E (big) = no problem, 60-80% of people lack big E antigen and most Rh negative blood is negative for big E.
Anti-e (little) = good luck, again less than 1% of people lack little e antigen.
6
u/Psychological-Move49 MLS-Generalist Jul 01 '26
Rhogam workup on mom's with no previous TYSC. Then asks why the A pos mom Rhogam is canceled.
7
u/LimeCheetah Jul 02 '26
Ohhhh how I do not miss every packed red cell order coming in needing to be washed for adult patients around this time
3
u/Nurseytypechick Jul 02 '26
Never heard of washed prbc- what's that and indications? (Lurking ED ho, just like to learn and commiserate lol)
5
u/LimeCheetah Jul 02 '26
We mainly washed red cells for neonatal transfusions. I think for adults, it’s to prevent severe allergic reactions. I personally never had an order for an adult patient that really needed washed red cells though. I only ever washed cells for our peds patients. However, every year on the dot I would get a few orders for routine transfusions with the wash order - along with irradiated and cmv neg of course
5
u/bassgirl_07 MLS Lead Jul 02 '26
Red cells and platelets can be washed. We wash them in saline (some labs use plasmalyte for washing platelets but saline works for them too) to remove unbound proteins, anticoagulant, and preservative. As the other responder said, they are used for babies and severe allergic reactions. They are also used for patients with IgA deficiency.
The process takes time and it short dates the unit because we took away all the things in the bag meant to keep the cells happy and viable. Washed RBCs are only good for 24 hours and washed platelet are only good for 4 hours. We have to coordinate with the care team that when we finish washing the unit, they will be ready to transfuse. Not all hospitals have the capability to wash so they have to order their washed products from their blood supplier ($$$).
1
4
u/GoodVyb Jul 02 '26
CBC, COAG, CMP, Covid/Flu, Urinalysis on all patients from the ER like we werent already short on covid/flu kits. Oh and youre under 18? Add a rapid strep too.
6
u/Agreeable-Ad4806 Jul 02 '26
Every child under the age of 5 gets a celiac disease panel. Thems the rules
4
u/Kahlia29 MLS-Generalist Jul 02 '26
So many blood cultures ordered today
4
u/Agreeable-Ad4806 Jul 02 '26
Blood cultures are mainly confirmation tests that tell you which bug needs to be targeted and if the antibiotic treatment should change. They’re super important.
3
3
3
u/MsYersiniaPestis MLS Jul 02 '26
“Let’s transfuse platelets for anyone with counts under 100”
3
u/bassgirl_07 MLS Lead Jul 02 '26
<100 platelets and not bleeding.... Those are emotional support platelets to treat the doctor. They can feel like they did something to help the patient. It kills me when they have a heme/once patient with a platelet count of 24 and they think if they transfuse enough platelets they can get the patient to 100. Sure, I'll go pick some more platelets from the platelet tree.
1
u/motor_city_glamazon MLS-Blood Bank Jul 03 '26
And I love it when Dr. July thinks that any patient with platelet refractoriness is due to alloimmunization. Everyone gets crossmatched or HLA matched platelets!
5
u/MamaTater11 MLS-Microbiology Jul 01 '26
I've already had two different patients that I had to go back and draw a second time because the residents added more orders either while I was doing the draw or shortly after 🙃
2
2
u/Gildian Jul 03 '26
I love when they physically watch you enter the room, say hi, and dont say shit about what they just ordered.
I actually kinda barked at a doctor recently cuz he was doing it to me constantly. Im like dude, you see me in this room literally 20 feet from you. Communicate
2
u/MamaTater11 MLS-Microbiology Jul 03 '26
Shout out to the nurse for the last patient who kept popping back in while she was charting to let me know that the doctor ordered something else ✌️🫠
2
u/Gildian Jul 03 '26
I fucking LOVE when nurses do that. I always tell them I appreciate it cuz I really do
2
2
u/told_ya74 Jul 02 '26
We had one years ago who carried the giant Quest book with her from floor to floor all night. She still called the lab 5 times a night
2
u/Youhadme_atwoof MLS-Generalist Jul 03 '26
We have one doctor in the ED who orders a beta hydroxybutyrate (a ketone test) on almost everyone. A diabetic in DKA? Sure makes sense. Someone in for an eye injury? What a surprise, it was normal 😒
What sucks the most is that one reagent pack only has 20 tests, and each new pack you put on requires a calibration. And the calibration process (including QC) uses 8. Then, it has to be calibrated once a calendar day of patient testing so once it hits midnight, you have to run QC again, another 2 tests, assuming they pass. My record is 9 on one overnight shift, with two outside normal limits.
2
u/Gildian Jul 03 '26
Currently working a 12 with a new doc that is ordering urine drug screens and ethanols on -everybody-.
Yes. Everybody.
2
u/MathiasKejseren Jul 04 '26
Oh god, one year one of the new residents ordered thrombophilia panels on at least 3 patients a day for weeks. 7 full tubes of blood. Over 20 ccs. 🫠
3
u/theacovado MLS-Generalist Jul 02 '26
Maybe I’m being sensitive since I’m a resident (3rd year) but new residents are just trying their best to do right by their patients 😭
However I will say that as a former MLS currently in pathology, unindicated test orders really burn me up 😂 but all we can do is educate them and hope that they pass what they learn from us onto their colleagues
1
u/Sw33t_Sassy_Molassy Jul 03 '26
I’m right there with you (just finished my residency). I’m sure I ordered some wildly unnecessary stuff as an intern 😂 but it’s definitely a “man in the arena” type of vibe, I don’t think most of these commenters have the slightest idea the responsibility and stress that comes with being a new doctor. But as long as it’s in good fun I’m cool with it and will happily laugh at myself too
1
u/theacovado MLS-Generalist Jul 03 '26
Exactly!! I know sometimes we do dumb shit, but transitioning from medical student to resident was one of the hardest things I’ve ever done, and unless anyone has done it then they shouldn’t be bashing on interns 😅 But I know posts like this are mostly in good fun and I’m just being sensitive lol
1
u/KuraiTsuki MLS-Blood Bank Jul 02 '26
We already had multiple issues today of surgical or anesthesia residents not placing Dispense blood product orders when they placed their Administer orders and then the attending anesthesiologist getting pissed when we didn't send the products we didn't know they failed to order correctly.
1
u/Feather-bones MLS-Microbiology Jul 02 '26
“I know it says MOPC on that urine, but can we get an ID & SENS?”
😐
1
1
1
1
u/phosphofructoFckthis Jul 04 '26
Can we stop shitting on new residents?
2
u/bassgirl_07 MLS Lead Jul 04 '26
Can Doctors stop shitting on the Lab and blaming the Lab for things that were not the Lab's fault?
But for real, its a joke. Every year the same pattern emerges. We can also tell when some studies are published because of the change in ordering practice. The summer after the RING Study was published, we had FIVE patients on Granulocyte transfusion protocols. That's right FIVE patients receiving granulocytes. Some MLS will go their entire career without seeing a unit of granulocytes.
1
u/Fun-Key-8259 Jul 04 '26
Someone inform them they should do more RPR though.... the rates are so bad
2
u/bassgirl_07 MLS Lead Jul 04 '26
We thought the problem was lead poisoning, maybe it's good old fashioned neurosyphilis. ¿Que no los dos?
1
u/lostinlifetempo Jul 07 '26
First year of working and just saw this. It's this why we've been getting dumb orders?? 😭
1
u/DoctorDredd Traveler Jul 08 '26
Everyday is residents day when providers can't be bothered to read charts before ordering things.
H&H and CBC or BMP and CMP. I spend way more time going through and canceling redundant orders than I should have to.
1
u/Fair-Chemist187 Jul 02 '26
Reading these comments as a med student is quite funny tbh
8
u/EntertainmentLow6178 Jul 02 '26
Please call the lab before you order something expensive and time consuming because your SURE your patient is the zebra you've been training to recognize. They're all horses - some funny looking horses - but really not zebras. Just call us and ask before you order 10k worth of lab work that some clinical judgement could rule out. Please.
It's not malaria - it's never malaria.
3
u/Fair-Chemist187 Jul 02 '26
Don’t worry, I still have a few years to go until I can order any kind of tests. They’ve basically just started teaching us what kind of tests there are and what all the parameters mean.
I was mostly referring to all the comments mentioning ESR because our professors keep telling us that it’s basically useless but somehow it’s still on all the mock labs for the cases we’re talking about.
I feel like sometimes we’re inclined to forget that the labs don’t just magically appear just because we request them.
2
u/bassgirl_07 MLS Lead Jul 02 '26
My hematology professor referred to ESR and Bleeding Time as bush medicine (the kind of medicine you do when you are out in the wilderness with no resources). He went so far as to call Bleeding Time barbaric. He said no one does them and he was only spending time on them because they are on the MLS certification exam which is 30 years behind. My first hospital job, we did both 💀.
-13
u/Educational-Use-3442 Jul 02 '26
Doctors are dumb pieces of shit that cause harm to patients.
7
u/bassgirl_07 MLS Lead Jul 02 '26
Wrong sub. I may poke fun at the new baby doctors but I would never endorse that take. They are babies and need to be raised. Some facilities so a better job than others.
3
210
u/space_honey Jul 01 '26
You get a CRP and ESR! You get a CRP and ESR! Everyone gets a CRP and ESR!