Wednesday, November 16, 2005

Oh, the learning curve

Did we learn about labs in school? I don't think so. I think that there should be an elective about lab result interpretation. Mind you, newFNP attended a well-respected institution, but has somehow made her way through without having a good understanding of lab results. Don't think for a minute that I can't interpret a CBC, because I can, but when you start throwing a jacked kidney my way, I am flat out lost. When there are too many numbers in the 'abnormal' column, my eyes glaze over as though I am back in C.O.C.

Case in point. I had a patient last week who was an interesting looking little guy. 65 years old. First name: Latino. Last name: Asian. Not a common combination in my 'hood, but stranger unions have certainly happened. Skin was a little yellow looking, belly was really round. Maybe I should have picked up on that, but if I stopped to really consider every weird-looking, rotund patient who crosses my path, I would have no time to peruse the internet for Sigersons and flattering Theory trousers.

My patient also had a very chatty wife who accompanied him to his physical and freqently interjected her own tales of health woes throughout his exam. NewFNP can only handle so many distractions and annoying chatty wife was throwing me off my game.

Long story short, Mr. Latino Asian likes to drink. Hell, newFNP likes to drink, but not like this guy! I drew his labs and got this, amongst many other abnormal values, back:

Albumin 2.6 (3.8-5.0) So - low, right?
Bilirubin 6.5 (0.1 - 1.5) Let's call that one 'elevated.'
AST 113 (1-45) Remember - Alcohol, Statins, Tylenol
ALT 56 (1-55) Ding ding! Most normal lab value goes to ALT!!

Another provider took a nano-second glance at the labs and said "Oh, AST 2 times the ALT is pathognomonic for alcoholism." She then glanced at him and said, "He is clearly cirrhotic." He is??? Well, shit. If I would have known it was so obvious...

The problem is that many things need to be so flagrantly obvious. Your blood pressure 210/105? Buddy, you are one hypertensive motherfucker. Blood sugar in the 600's? I'll lay my money on diabetes.

But other seemingly obvious diagnoses escape me, to say nothing of the not-so obvious diagnoses.

On the bright side, I really feel like I have my charting/prescription signature nailed.


Nurse Practitioners Save Lives said...

The learning curve is why I continue to work on a med/surg floor. The obvious is sometimes not so.. I still get a kick out of diagnosing a patient before the doctor figures it out but I still have a lot to learn. It's a lesson every day.

Candy said...

And when his belly was tapped I bet it'll keep pouring out and out and out...right?

Resumeplus said...
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