#15: The Importance of the Clinic/Lab Partnership

Sometimes when I sit to write these blogs I feel as though I may be preaching to the choir.  After all, Abby emails these to clinics who send urine samples to the lab to be tested, so they most likely know the information I am attempting to deliver, right?  Not so much!  The questions we receive on a daily basis reinforce the necessity of the partnership the lab has with the clinics it serves.  Our job is to deliver accurate information to the providers in order for them to make the best possible clinical decision for their patient.  We take this seriously and writing this biweekly blog is a way to help insure we are assisting in the provider/patient relationship to the best of our ability.  If there is a subject matter involving drug testing you would like to have discussed please let us know and we will make every effort to include that in a blog.  

A toxicology report can be an intimidating bit of information to those unfamiliar with it.  Many providers are unfamiliar with the complexities of UDT and therefore fail to use it.  One study I recently read found that only 8% of family physicians performed UDT for patients they had on some form of chronic opioid therapy.  The reasons given for the absence of testing were: the providers did not know which patients to test, how often to test them and what the results of the testing meant.  Experience has taught me this is not limited to primary care physicians.  Although it is not the lab’s job, nor are we allowed to practice medicine, I do think it is our responsibility to help educate providers on drug testing.  This does not mean mark a requisition form telling them to test everything, but instead our responsibility is to deliver all of the objective and accurate information necessary enabling the provider to make the most appropriate medical decision for their patient.   

Sadly, in many offices, urinary drug testing has become an inexpensive insurance policy for provider liability protection.  Instead of using UDT as intended, many providers simply use UDT as a means to discharge patients from their practice.  Clinically the benefits of UDT include reducing the risk for toxicity from adverse drug effects, detecting patient non-compliance, reducing risk of therapeutic failure and avoiding or detecting drug-drug interaction.  As your toxicology lab we are here to assist you in taking advantage of those benefits.  Although on occasion it becomes necessary, discharging patients helps no one.  Please take advantage of the lab personnel cell phone list and let us help with your questions.  

As always, we appreciate your business and thank you for it.  I leave you with a quote from Aristotle:  “We are what we repeatedly do.  Excellence then, is not an act, it is a habit”.     

Lance Benedict

 President/CEO Industry Lab Diagnostic Partners 

7/26/2019

#14: What if... it is Personal?

In July of 2008 a 17 year high school junior was setting off fireworks by lighting them and then dropping them down PVC tubes.  They would explode out of the open end of the tube and the display was mildly spectacular, until…..He mistakenly dropped one down one of the tubes with the point down.  When it went off the compression had nowhere to go and the PVC tube exploded, imitating a grenade.  A sharp jagged piece of the tube, traveling faster than the eye could see, entered just below his knee cap opening a two inch slice down to the patellar tendon.  The young man was carried to a vehicle, and rushed to an ER where he spent the night.  He was given Opana for his pain.  The following day a surgeon explored, cleaned and closed the gaping wound.  He was given antibiotics, a script for 90 Opana and sent home on crutches. 

Skipping ahead 8 years, to the fall of 2016, that same young man is found by his mother in his pickup truck at 2 am outside his girlfriend’s apartment, with a needle and syringe sticking out of his arm.  His lips were blue and he wasn’t breathing.  She pulled him from the truck and did CPR on him for what seemed like forever, waiting for the ambulance.  

My wife and I were vacationing in the Black Hills of South Dakota and it is never good when the phone rings at 3 am.  I can still hear my wife’s screams, and those of her sister, as she informed my wife our 25 year old nephew, Tyler, was dead from a straight heroin overdose.  

The next 24 hours, getting back to Tennessee, as well as the months that followed, remain a blur.   I debated a long time prior to sharing, however I made up my mind to do so last month while sitting in a Tennessee Federal court watching my nephew’s dealer get sentenced to 10 years, down from the recommended 19 years.  Listening to the judge pontificate about the shared responsibility of the drug user and the drug seller, my mind drifted to what ifs... 

What if the ER doctor and the surgeon prescribed three to five days of Hydrocodone verses 90 Opana?  What if the caregivers spent a little extra time explaining to Tyler and his parents the reasonable expectations regarding the pain medication?  What if my sister and brother in law knew what to look for prior to allowing him to get a second script of Opana from his primary doctor?  What if they had called me before he had already been in two different treatment centers?  What if I stepped up and told him how dangerous it was to drop fireworks down PVC tubes?  I was the one who carried him to the truck and rushed him to the ER.

Yes the questions could go on forever.  I am sure those in the cheap seats have the answers to some of these questions, and I don’t pretend to be ignorant of the culpability of my nephew.  When I see the reports of some of your patients, I see my nephew.  I know the struggles they go through.  The pain they cause their families as well as those in their lives.  The anguish they live with moment to moment.  ILDP takes drug testing seriously.  We respect you and your patients and report with the highest level of accuracy.  We do appreciate you trusting in us.  Thank you for your business and please take a moment to reflect on all of the blessings you have in your life.  

Lance Benedict

President/CEO Industry Lab Diagnostic Partners
7/12/2019