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.
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
What a great idea! Sed rates! I wonder if it’s because we do so few GC/Chlamydia probes and strep-swabs now? I suspected all along it was largely a financial issue, not a regulatory one. Thanks for the note!
RKM
12 years ago
I wonder if the same budgeting team that skimps on glove quality are willing to do real world testing?
Mary Beth
12 years ago
We went thru this too and they took all of the cards and developer out of the rooms. So now i walk around with my globed finger sticking up, asking for card/developer, and spreading feces/e coli throughout thr department. Big improvement.
The Uk was the very first country affreux across the lap of fiscal austerity. Conservatives in Britain argued that authorities deficits may be solved by slashing manifeste investing promptly and severely. They obtained what they needed, such as a particularly drastic set of cuts impacting the country’s very poor and unemployed. But despite the cuts, Britain’s economic climate has not recovered.
We still watch dvds and they do have Wii and Xbox, but time on those is strictly limited to one hour each on weekends and now the weather has improved they are usually outside all day anyway.
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Thanks for the article. I have always observed that the majority of people are desperate to lose weight simply because they wish to appear slim and attractive. Nonetheless, they do not always realize that there are additional benefits to losing weight as well. Doctors declare that fat people have problems with a variety of health conditions that can be directly attributed to their particular excess weight. Thankfully that people who’re overweight in addition to suffering from numerous diseases can help to eliminate the severity of their illnesses by way of losing weight. It’s possible to see a steady but noted… Read more »
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They tried to pull the same crap on us… 😉
Being a Canuck ER, I told the administrator that lab stool occults would sink universal healthcare down the toilet.
We still do our own haemoccults.
I promised to be a good boy and keep sending them sed rates.
What a great idea! Sed rates! I wonder if it’s because we do so few GC/Chlamydia probes and strep-swabs now? I suspected all along it was largely a financial issue, not a regulatory one. Thanks for the note!
I wonder if the same budgeting team that skimps on glove quality are willing to do real world testing?
We went thru this too and they took all of the cards and developer out of the rooms. So now i walk around with my globed finger sticking up, asking for card/developer, and spreading feces/e coli throughout thr department. Big improvement.
Funny how improvements, designed by those out of our work areas, are almost always regressions!
The Uk was the very first country affreux across the lap of fiscal austerity. Conservatives in Britain argued that authorities deficits may be solved by slashing manifeste investing promptly and severely. They obtained what they needed, such as a particularly drastic set of cuts impacting the country’s very poor and unemployed. But despite the cuts, Britain’s economic climate has not recovered.
We still watch dvds and they do have Wii and Xbox, but time on those is strictly limited to one hour each on weekends and now the weather has improved they are usually outside all day anyway.
I am sorry but how did god get within the discussion to begin with? The post I just study was a couple of gentleman and a shark, failed to see god’s brand anyplace within the short article. Just holy rollers making an attempt to push their faith on everyone!! Oh and if god exists then why does god permit guy destroy nearly one hundred million sharks a 12 months and then god tells the shark to save the male that kills his species??? I do not consider so!!!!!!
I’m not sure I appreciate what you mean.
Please let me know if you’re looking for a article author for your site. You have some really good posts and I believe I would be a good asset. If you ever want to take some of the load off, I’d absolutely love to write some articles for your blog in exchange for a link back to mine. Please send me an email if interested. Regards!|Have you ever considered about adding a little bit more than just your articles? I mean, what you say is valuable and all. But think about if you added some great pictures or videos to… Read more »
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Hey would you mind stating which blog platform you’re using? I’m going to start my own blog in the near future but I’m having a tough time choosing between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your layout seems different then most blogs and I’m looking for something completely unique. P.S Sorry for being off-topic but I had to ask!
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