This is a contribution from my dear friend and colleague, Dr. Billy Campbell.  Billy is a family physician in Westminster, SC, a passionate and widely knowledgeable naturalist who also runs Memorial Ecosystems, and environmentally friendly cemetery/nature preserve.  Here’s a link to that.

hemoccult card

Our hospital has realized that we weren’t following national lab guidelines in being regularly instructed and certified in the use of Hemoccult and Gastroccult cards.  These are the little things you dab stool or stomach contents onto, and then apply a developer to detect blood.  So no physician can now do them, but has to send them to lab.  Except ER doctors like myself, who have to take a training session.  Of course, we’ve all done it for the many combined decades of our careers, but a rule is a rule, they say, no matter how inane.

Here is Dr. Campbell’s astute suggestion to the hospital administration.

Proficiency Seminar for Conducting Hemoccult Testing: Making a Fecal Mountain out of a Skidmark

Day 1

Basic Concepts

Hour 1: Why blood sometimes is found in stool and vomit.

Hour 2: Things that look like blood but are not: more than beets and bismuth.

Hour 3: Color Transition Chemistry. What causes false positives? Why should you care? In a quantum universe, can it be both positive and negative at the same time?

Hour 4: Why using gloves is recommended: false nail/hang nail false positives, basic hygiene, avoiding misunderstandings .

Lunch Break (Polish sausage with red-sauce, dark chocolate and peanut ice cream)

Hour 6: Informed consent and ethical issues

Hour 7: Testing (Note! Failure on the 300 item test will require repeating the entire 1st day, and participant will not be allowed to proceed to day 2.)

Hour 8: Optional post-testing Smell Lab with melanotic stools, stools with iron, etc.

Light hors d’oeuvres : black bean dip and chips

Day 2

Performing the Test

Hour 1: The Anus: Where is it, and why in some cases it is hard to find?

Hour 2: To Lube or Not to Lube? Patient comfort, false positives. Why lard, soap and “warming massage oil” are not recommended.

Hour 3: Checklist of needed materials and ancillary personnel: avoiding walking around the hospital with a dirty glove in search of a card. Room set up to include wine, cheese, candles and “mood music” to relax patient.

Hour 4: Considerations of patient placement. Including special considerations for morbidly obese, those on the ventilator or other conditions that preclude “assuming the position”. Why removing or pulling down underwear is imperative for accuracy.

Lunch Break TBA

Hour 5: Demonstration of probing anus/rectum: maximizing information flux; straight in and out, or deep rotation?

Hour 6: Using the card: which window to open first?

Which goes first, stool or developer?

Know the controversy: Dab or smear? Expert Panel Discussion to follow.

Closing the window. What do those two little thingies at the bottom mean? Why does only one turn blue? Does that mean the card has been contaminated?

Hour 7 Paperwork and documentation.

Question and answer

Hour 8: megarectal proficiency testing with volunteer administrators

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