Tag Archives: clinical information

“Hand holding and Chinese whispers..”

As part of my job as a clinical microbiologist, I am usually on the telephone 20-30 times per day.

That is a lot of telephone time for a man…

With regards to outgoing calls, a lot of these are simply information gathering. For example, is this patient with Gram negative bacteraemia on appropriate Gram negative cover? Has this patient with Clostridium difficile infection been isolated and treated? Has this patient with Staphylococcus aureus bacteraemia been investigated properly?

Gathering this information by telephone is of course always a little fraught with difficulty. Trying to get hold of the right person to speak to can take up a lot of valuable coffee drinking time. There is also no guarantee that the information you are given is accurate, and has not evolved along a chain of “Chinese whispers”. Sometimes you finish the phone call no more enlightened than when you started…

Many of these calls would not be necessary if the hospital/health network had a live, real time “Electronic Health Record”, along with an electronic/digital drug chart for each patient. These innovations simply cannot come soon enough to my neck of the woods. Objective, readily accessible clinical information is what microbiologists crave.

Incoming calls are generally from clinicians looking for advice on antibiotics, infection control, optimal samples, etc. Much of the information that I give out could easily be accessed from published clinical guidelines. There is often an element of “hand holding” here, of sharing the responsibility for the decision made, and sharing the blame if something goes wrong..

Personally I was never very good at hand-holding…

And then, once or twice a day, an interesting phone call comes along, one which stimulates the mind, and prompts further thought and reading, and reminds me that I do after all work in a microbiology laboratory, and not a call centre…


“A Site for Sore Eyes”

It is not just the clinical details that are important in how a microbiology sample is worked up. It is also where the sample was taken from, as you will be perfectly aware.

However sometimes the site labelling can be a bit too “generic”.

For example an “ear swab” could potentially mean a swab from the auditory canal (i.e. in someone with otitis externae), or it could mean a swab from the skin on the outer ear (i.e. in a patient with impetigo lesions).

The same can apply to “nose swab”. This could mean the skin covering the outer nose as opposed to the inner nose or nostril.

As a final example a “penile swab” could mean a swab from the urethra or it could mean the skin on the outside of the penis.

and there are others.

But why does this matter?

You have probably worked this out already. The microbiological work up from the two different options on each “site” is completely different. We are looking for different microbes, using different media or tests, and even the reporting procedure, susceptibility testing and comments are all different.

It is therefore critical that the requestors (and sample takers as these are not always one and the same) are educated to be as specific as possible when describing the sampling site e.g. outer ear, ear canal, nostril, outer nose, urethra, penile skin, so that the scientist is in no doubt as to where the sample has been taken from so that correct processing can take place. The education needs to also explain why it is so important from a lab perspective.

Another solution is to define the sites in detail as tick boxes on the request form, but tick box request forms have their own set of problems….

The more useful the information that comes into the lab, the more useful the result is to the patient.