Q & A |
May 2002 Q. Our laboratory recently lost potential business for Pap test interpretation. The chief reason the gynecologist cited was that the competing lab sent out complimentary "happy cards" to all patients with negative Pap tests and that this reduced the number of calls to his office and the number of mailings to his patients. I have heard that the practice of sending cards of this type might represent an illegal inducement because it could be viewed as supplying a service at no charge in exchange for business. What is your interpretation? A. Arguably, the "happy cards" are simply an enhanced service of the laboratory, a method of conveying the testing information. Under that interpretation, the cards would in no sense be a financial inducement. Even if the happy cards were viewed as a value-added service, the cost of the cards and the financial benefit to ordering physicians are so small that a prosecutor is highly unlikely to pursue this practice as an illegal financial inducement. James C. Dechene Q. Can you comment or send me references on the validity of determining a lipid profile during the first 24 hours of myocardial infarction? A. Acute myocardial infarction is associated with a variable decrease in total cholesterol and low-density lipoprotein-cholesterol concentrations in serum.1 The change depends on the original level of cholesterol in serum, with little change at serum levels below 5.17 mmol/L (200 mg/dL). In one study, cholesterol measurements obtained within 24 hours after a myocardial infarction changed little from those made before the myocardial infarction.1 Thereafter, the serum cholesterol level decreased gradually to a lower level for an average of six to eight weeks. In a second study, investigators observed that the lipid state of the individual could be assessed accurately during the first 48 hours after an acute myocardial infarction, but that after two days, significant decreases were observed in total cholesterol and LDL-C serum levels.2 Therefore, measuring cholesterol within the first 24 hours after a myocardial infarction is a reliable way to assess a patient's serum cholesterol level and a possible screen for hypercholesterolemia. This is also of note from a practical standpoint since blood is likely to be collected during the first 24 hours of myocardial infarction for various other biochemical tests and less likely to be taken routinely months after the attack. References Gary L. Myers, PhD Consultant, CAP Chemistry Q. What are the latest CAP recommendations regarding surgical pathology reports? I am familiar with "addendum" and "amended" reports, but I have heard that CLIA now requires use of "corrected" reports. Does this terminology apply to anatomic pathology reports or should it be used only for clinical laboratory numerical results? A. Whenever a pathology report is revised or amended it is essential to ensure that the treating physicians clearly understand that the report has been changed and the nature of the change. This need for clarity is as important for anatomic pathology reports as it is for clinical laboratory reports. The College's Laboratory Accreditation Program does not specify the terminology used to designate report types, but LAP does require that such reports be clearly designated and that "corrected" results reports clearly state that the new result is a change from a previously reported result (see LAP checklist No. GEN.43700). In some cases, the terms used for report types are determined by the laboratory computer system and cannot be altered. For example, in the Meditech system, all pathology reports issued subsequent to the final report are called "addendum" reports. Nevertheless, the laboratory can clearly identify such reports as representing a "corrected" or "revised" report in the printed text. The following descriptions of report types are taken from the new CAP Quality Improvement Manual in Anatomic Pathology1:
Regardless of the specific term(s) used, communication with the treating physicians and a clear explanation of the purpose of the new report are essential, particularly when the change may affect patient care. Reference Patrick L. Fitzgibbons, Chair, CAP Surgical |
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