Butter Side Down

I have a quirk — a troublesome habit, one might say — that frequently drives me to question the methodology used to derive results that appear in various reports.

Especially when such results are outlandish, given the rest of the data.

This quirk doesn’t always make everyone else happy.

Today, at the request of a friend, I reviewed a set of blood tests that showed that blood drawn from him has “zero” parts of a particular constituent that makes up human blood.

Say what?

Indeed, Oh Best Beloved, that’s what that printout said.

Now, it is possible, just possible, that the test results are accurate.

Highly unlikely - but possible. If, for example, the blood had come from an individual who had been sitting inside the center of a nuclear reactor, why, then, the result documented so nicely on the laboratory’s test findings is exactly what this particular blood test should show.

Since my friend isn’t glowing in the dark, and has perfectly normal results for all the other indicators that would have been blown out of the water by radiation poisoning, it seems a trifle unlikely that massive (or long-term lower dose) radioactive exposure explains this little oddity in his blood work.

So. Shouldn’t one then wonder if perhaps, just perhaps, that blood test might have a teeny tiny little error in it?

Apparently, according to “Debbie” at the laboratory, one should not. One must call “doctor” because “doctor” will explain what the lab results “mean.”

Fine and well. Except that’s not what I had asked Debbie about. I had asked Debbie which specific methodology was used to obtain the results in her lab tests. As an aside, Debbie already knew that an MD hadn’t ordered these tests. These were done at a “direct access testing” laboratory, and ordered directly by the individual who had the blood drawn. This is a perfectly legal process and available to anyone who wishes to pay for it here in the USA.

And… I specifically didn’t want any interpretation of the results, as they aren’t my blood tests. I had no interest in asking questions about someone else’s medical information. Just in case, I’d covered that by having my friend call first to give the lab permission to talk to me specifically about his results, if necessary. Debbie was actually calling me - based on that request to her lab from my friend. I hadn’t called her.

“I’m not asking for an interpretation of the results,” says I. “I’m asking, as I’ve already explained, if this test was run using a machine scan or via human inspection. The results look like you ran it via machine, and the machine hiccuped and gave a false zero.”

“You have to ask “doctor” what the lab results mean.”

“I don’t know anyone named “doctor,” says I, with a tad of annoyance. “And, let me repeat once again, I am not asking what the lab tests mean. I am specifically asking what methodology your lab used to run this blood work for this specific count because, quite frankly, the results looks like lab error. And if it isn’t lab error, then we’ve got some extremely odd results that may indicate an individual with a serious health problem. So if you can’t answer my question, please find someone who can and get them on the line.”

“You’ll have to ask ‘doctor.’”

“‘Doctor’ won’t have an answer, Debbie, because the question is, ‘what methodology did your lab use to obtain these results? Mechanical or manual diff?’ It’s not reported on the form, so any MD that looks at this information won’t have that answer.”

“You’ll have to ask ‘doctor.’”

Have I ever mentioned, Oh Best Beloved, that my paper on the statistical problems and errors inherent in laboratory tests has been and is used to teach students at universities, and medical personnel, about the limits of such diagnostic tests? Have I ever mentioned that the information about which methodology is used in a test can make a critical difference in interpreting the accuracy of the results? Have I mentioned that this information isn’t the least bit secret and laboratories know this and provide information as to testing methodology quite freely to anyone who asks for it, just for this reason?

And have I mentioned, Oh Best Beloved, that I find stonewalling a trifle annoying? Annoying in a way akin to the annoyance that hornets feel when a stick is poked into their nest?

I believe, I truly do, that Debbie now understands that.

Just call me “hornet.”

The blood work results were indeed obtained by the machine based methodology, and are therefore likely in error.

I would be remiss if I didn’t express my deepest thanks to Debbie’s replacement, “Crystal,” who not only knew the answer to the question I had asked, but also was pleasant and professional to boot.

A piece of unsolicited advice for all the “Debbies” out there: be careful where you poke your stick.

You might just encounter a hornet.