Blood Test Economy

Since government put a drastic measure in saving Malaysia's Economy, budget has been cut across all government sector. It was necessary. I cannot disagree on that measure, no matter how much I like to disagree. In hospital situation, pathology department also affected by this budget cut. As far as I know, everyone are doing their best to survive the economy.

What will change when you saw budget cut in ministry of health or specifically hospital? Perhaps would imagine that they will be cut on food expenses for the luxurious food serve on every course in hospital as pictured by the public - we all 'kuat makan' stereotyped- not like them in private sector (actually they do cut our budget on that), or maybe you imagine less computer, less electricity, or less drugs, less quality of management? 

No. It's complicated as everything in government hospital need to operate like it should and still maintaining the same quality of service if not improve with less money on hand. This immediately effect us working in lab. 

A request for blood test now is not just a blood test like before. It now equals to 'your money and my money' kind of thing. It's not just patient's money, it's not government money, it's our money. 

However, there is this ugly habit that most doctors in Malaysia practiced, it's not right medically or ethically but we use to do it anyway, requesting for unnecessary test for the reason of ' just to be safe'

Defensive medicine... I've talked about that before. Its not written in any medical book but defensive medicine is what most of us are doing today. As medicolegal cases increasing everywhere in this country, doctors were threatened to do everything even if its not necessary. 

(Some physician out there will disagree with me. I know, it's better to be safe than sorry.) The habit able to stay alive for so many years (even some senior doctor and consultant are against it) because we have a good economy before than now. With this bad economy, the ugly side of this habit surfaced. 

We, those working in lab, have to deal with it everyday. As we are getting strict on blood request by the clinician, as so the clinician are getting strict with us for the reason of patient safety. We were like a middle man in a bad business industry. Approve it, we lost money, and perhaps we will not be able to run any more test before the end of the year - reject it, then we are also doctors, who learn medicine and were told to put patient safety first before anything else. 

Knowledge is the key factor that can solve this hassle. By having adequate knowledge on how to diagnose a patient and knowledge on the proper monitoring, and knowledge on discharging plan, will somehow reduce the request for the unnecessary test. And by saying that, I am kind of giving a statement that doctors are not that knowledgable and it bring us to the fact that there are some defect in our training system. 

House officer, medical officer, and specialist somehow make the same mistake on ordering the unnecessary test. Who to blame now? Medical school? Medical officer? The training for specialist? Consultant? (Blame it on government because they cut our budget. However, overseas where medical fee are not free, requesting unnecessary test which end up in patient bill will cost you to go to court. Should not blame the budget cut anyway)

Whoever to be blame, it's not the priority as it was too late to do so now. What we need now is for everyone to think that our money is running low, we could save some for some other patient in the future or finish everything and pray for magic to happen later when we run out of reagent for blood test. 

So when somehow, a pathology medical officer call you and tell you that it was not necessary to do that test, don't think that we are so stingy, it not our money after all..it your money and my money too. Have a knowledge back up discussion, it will solve many thing. 

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Example of unnecessary test:

Patient with chest pain and st elevation on ECG. CK, AST, LDH sky high. Order for Trop I to confirm diagnosis of Myocardial Infarction (?)

Patient having dengue fever with low platelet. Order for Peripheral blood film to rule out causes of low Platelet. 

Patient having fever and URTI symptoms. Heart rate 110 bpm. Order thyroid function test to rule out hyperthyroidism causing tachycardia. 

Patient presented with symptoms of hyperthyroidism. thyroid function test confirm that the patient indeed have hyperthyroid biochemically. Order another thyroid function test 2 days later because patient still having hyperthyroid symptoms. 

Patient having fever, left leg swelling, erythematous, underlying diabetes mellitus. Treat as left leg cellulitus, order D-Dimer to rule out deep vein thrombosis (leg swelling?)

Patient OGTT normal, fbs normal. Having polyuria. Order Hba1c to rule out diabetes mellitus (?polyuria)

Patient present with fever, jaundice, leptospira IgM positive, hepatomegaly..order Paracetamol TDM to rule our paracetamol poisoning causing jaundice (??)

Patient came to casualty with shortness of breath, and body weakness. Order everything... fbc, lft, buse creat, uric acid, amylase, trop I, mg, Po4, Ufeme......

The list can go on.... no matter how stupid you think the example are..I did not make that up...all are true scenario.... They always said that we pathology just sit our fat arse in the lab and did not see the patient and we should just shut up and follow what they say.... but... we just can't let this happen. 

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