Friday, October 27, 2006

Have a heart

The other day I was doing the ‘cut-up’ – the process of examining and dissecting the surgical specimens that come to us from the hospital’s operating theatres, outpatient clinics, and the local GPs. Apparently in the US it’s sometimes called ‘grossing’ but most of the specimens aren’t as yukky as that might imply! The last specimen wasn’t adequately fixed in formalin yet so I put it back in its pot after having a quick look.

It was a heart

All the specimens come with a request card giving the patient’s details, the consultant looking after them, the specimen that’s been sent, and some ‘clinical details’. The rather nebulous sounding clinical details section should be filled with useful information including one or more of: what disease/problem or suspected disease/problem the patient has, relevant medical history and medication, what the person sending the tissue would like to know about it etc. It all useful information in helping us make the diagnosis, stage the tumour, or whatever we need to do with the specimen.

The ‘clinical details’ with the specimen simply said ‘heart’

No sh*t! I’d never have known, although the heart does have quite a characteristic appearance for those in the know. I presume the heart had been removed for some reason but why? And why keep it such a secret? Knowing a bit about the specimen helps us decide the best way to dissect it, which parts are particularly important to look at under the microscope, which stains we need to use to look at the slides and if we need to take samples for other more specialised tests.

The result is me wasting my time trying to get in touch with surgeons who are in theatre/in clinic/not in because they’re on nights. Just to get hold of information that should have been sent with the specimen. And then they ring me wanting the histology report ASAP. I sometimes feel like sending them a report ASAP saying ‘No clinical details were provided with this specimen.’ Or even (in the spirit of the request card) ‘Histology report.’ But I just ask them for the details. Maybe I’ll be more militant when I’m a consultant…..


At 19:34, Anonymous Anonymous said...

Dr K,

There's nothing to stop you adding a statement at the end of the report about the inadequacy of the clincial information provided-I usually say something like the quality of the information provided has compromised clinicopathological correlation and may compromise patient care-that normally gets clinicians on the phone sharpish. My comments are getting snottier and snottier as I get older and grumpier!

Good luck with the blog.

At 22:39, Blogger Dr K said...

Thanks anonymous. It depends which consultant I'm working with, some of them are more keen on these comments than others. I'm looking forward to writing my own snotty comments in future!

At 08:54, Anonymous a different anonymous said...

he he.. even as a lowly MLA in my student days we would get various body parts through the specimen reception either hastily labelled or totally unlabelled.

Best one I saw was a knee cap in a hastily wiped out sudocrem pot! :o

At 16:47, Anonymous Anonymous said...

Sudocrem pots! At least thats vaguely medicinal. We've had specimens sent in coffee jars, big sweetie jars, tupperware type lunch boxes...I just hope the theatres don't get them muddled up and someone gets colon sandwiches for lunch.;)


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