Creating a culture of
consumer advocacy for our students
Mary Ann McLane, PhD, CLS(NCA)
Associate Professor
Department of Medical Technology
University of Delaware
mclane@udel.edu, 302-831-8737
CLEC 2006
1
Objectives
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Compare and contrast “diagnosis” and
“assessment”
Correlate the experience gained through a
CLS/CLT curriculum with the ability to
formulate laboratory assessments
Use actual consumer questions to foster
consumer advocacy in CLS/CLT curricula
2
“..culture of consumer advocacy..”
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The need…
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Since 1999, over fifteen thousand
questions about laboratory testing have
come to the ASCLS consumer webpage
team
3
“..culture of consumer advocacy..”

1999: fewer than 1 question per day
2005: average of 65 questions per day!
YearlyIncreases
700
We always need
and welcome new
volunteers.
600
500
Number of Questi ons
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400
300
200
100
0
1
2
3
4
5
6
year s
4
CI requests by discipline
Hematology
15 - 20%
Immunology
20 - 30%
Chemistry
60 – 65%
Microbiology
0 – 5%
5
“..culture of consumer advocacy..”
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The need…
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Since 1999, over fifteen thousand
questions about laboratory testing have
come to the ASCLS consumer webpage
team
To Err Is Human
The Quality Chasm
6
“..culture of consumer advocacy..”
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The need…
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“we don’t diagnose!” mentality
7
“..culture of consumer advocacy..”
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The need…
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“we don’t diagnose!” translates into:
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We cannot use our talents and hard-won
knowledge/skill to make the connections we
were taught to make in school… I will be
reprimanded if I dare to link our testing to
diseases, and actually tell someone
All those case studies that we loved so much
were just a school exercise
Don’t ask me anything about micro since I no
longer remember it!
8
“..culture of consumer advocacy..”
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The need…
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Fewer clinical pathologists
Shorter times in the clinician’s office
Baby boomers who question everything!
Other healthcare professionals easily step
into the role of providing lab testing info to
those with questions, despite their NOT
being the experts

Nurses, diabetes counselors, pharmacists…
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“..culture of consumer advocacy..”
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The solution…
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Realize what we do is “laboratory
assessment” and not “medical diagnosis”
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Just as valid as nursing, PT, pharmacy, OT,
nutritional, etc. assessments
Include this as an expectation for our
students and colleagues, alike
10
“..culture of consumer advocacy..”
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The solution…
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Independent Practice, 2001
As professionals, clinical laboratory
scientists have the requisite knowledge and
skills to… interpret laboratory tests… and
collaborate in the diagnosis and treatment
of patients by implementing initial and
reflex testing protocols within prescribed
guidelines.
11
“..culture of consumer advocacy..”
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The solution…
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Scope of Practice, 2001
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Clinical laboratory scientists may appropriately provide…
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Advice upon the design and service scope of clinical
laboratories;
Advice to physicians in the appropriate utilization, selection and
sequencing of clinical laboratory tests and, in collaboration with
attending physicians, determining clinical correlations and
interpretations of the quality and utility of specific laboratory
results;
Advice to other users and consumers of clinical laboratory
testing services upon appropriate use, maintenance, quality
assurance and other procedural and informational
requirements.
12
“..culture of consumer advocacy..”
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The solution…
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Direct Access Testing, 2004
…it is the role of certified clinical laboratory
scientists to consult with consumers about
the purpose of laboratory tests and the
general meaning of laboratory results in
whatever setting those test results are
generated, including direct access testing.
13
A first step for developing the culture
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Junior/senior level CLS courses
Insights into the legal, ethical and
“user-friendly” aspects of responding to
consumer questions
Use of questions from ASCLS Consumer
Webpage
14
A first step for developing the culture
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Depth of knowledge needed is very
obvious
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Hints at need for continuing education
after graduation
Questions more realistic than synthetic
ones in most texts
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Will automatically contain not just the question
but the anxiety, the confusion…
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A first step for developing the culture
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Topics easily interwoven
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Quality assurance
Statistics
Method comparison
Clinical Correlations
Empathy
Ethics
Attendance at annual Legislative
Symposium
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Legislators need to be educated, too!
16
A first step for developing the culture
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University of Delaware syllabus for
MEDT401
“Patient Advocacy within the Medical
Technologist’s Scope of Practice”
17
Hematology Examples
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My hematocrit was 16 and I had to have an
infusion, but I am still suffering with
headaches. Is it normal to have headaches
with a low hematocrit?
My WBC is 3.2 and the range is 4.0 – 10.0.
The doctor told me my lab tests were fine,
but on my copy there is an “H” next to the
MPV of 10.7.
18
Just a little information, please

I was wondering if you could answer a
question about leukemia for me. I need
to know what types of blood tests are
done on what types of cells and
possibly a few details on each of them
to diagnose leukemia.
19
Healthcare provider examples
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What is the quickest and most efficient
way for a patient to increase their
hematocrit level?
I just had a routine physical exam. I’m
an RN and would like to know what a
platelet count of 700,000 and a WBC of
21,000 indicates. Why am I being sent
to a hematologist?
20
Worried mother
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My son is a 5 years and 3 month old Chinese
boy. His segs is too low and his lymphs is too
high. He did not have any symptoms when I
brought him for the blood test. I am really
concerned. Do you think he may be infected
with HIV. Do you think he may have
leukemia?
21
Patients’ right to know
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I just finished treatment for dysgerminoma
and had my follow up blood work. I am
concerned about my eosinophil percentage of
34.0 when the range is 0-4. I called my
oncologist’s office and the nurse told me that
the only thing they look at is WBC, ANC and
MONO and that patients should not
receive copies of their blood work
because they don’t know the
significance of anything and they would
tell ME when I should be concerned.
22
Frustrated daughter
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All I am trying to find out is what the effect
on the body of someone having a very low
(1,000) platelet count is. My mother has
been receiving platelet infusions.

Several messages later - diagnosis of RAEB
(Refractory anemia with excess blasts) – trying to
make decision to continue treatment – I referred
her to social services at her local university,
mentioned hospice and sent her information on
MDS (Myelodysplastic Syndromes).
23
Good teaching material
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RBC
3.69 x 109/L (4.1-5.1)
HCT
24.1% (35-47)
HGB
7.3 g/dL (10.9-15)
What is
MCV
66.2 fL (80-100)
your
assessment?
MCHC
30.3 g/dL (33-36)
Fe
2.7mmol/L (6.6-26)
Ferritin
3 µg/L (30-180)
I have been very tired and all I want to do is to eat
ice. What do you think my problem is?
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A chance to educate patients
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My hemoglobin is 14.2 and my ferritin is 13.2
(20-120). How can my ferritin be low when
my hemoglobin is good. Don’t they both
involve iron in your blood?
My father just had blood work done and his
HGB was >20.0. He has lung problems and
is a heavy smoker. Can smoking and lung
disease affect his hemoglobin?
25
Coag Examples
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I take Coumadin and I used to get my
PT results in seconds. Now I get an
answer called an INR. Is that a new
test? Nobody can explain to me what it
means – just that it is the way the
report is now given.
What are the symptoms of an INR of
8.0?
26
Scary, but with a happy
ending…

I had been on
coumadin for a month
without any monitoring.
I wanted to get off, so
the doctor ordered an
INR. It came back 11.1
and he called me at
work to come right to
his office for a shot of
vitamin K.

The doctor apologized.
Three days after the
vitamin K shot, my INR
is 1.6. No one told me
that I could not take
fish oil or that there
were any diet
restrictions while taking
coumadin. Thanks for
all your information.
27
This is a foreign language to
me
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I was found to have an elevated APTT in preop screening. I have never had any bleeding
problems. I was told that I have a lupus
anticoagulant as evidenced by the positive
hex phase study, elevated ACAs and inhibitory
pattern in multiple factor levels. I was told
that because of the lupus anticoagulant that I
might be at increased risk of post-op
thrombotic episodes. What does all this
mean in plain English?
28
Some questions are fairly easyand some more complicated
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FAIRLY EASY
What is thrombosis?
Why would my
physician suggest that I
take a baby aspirin
every day??
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NOT SO EASY
My daughter has been
diagnosed with Klippel
Trenaunay Syndrome. Her
doctor wants to start her on
Coumadin. How does that
relate to KTS?
My baby has been diagnosed
with Kawasaki Syndrome. Is
it usual for the platelet count
to approach 1 million?
29
Chemistry scope of questions
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A recent test indicated my ALT was fine but my
AST was 15 (the range being 16-40). What does
a lower number mean? Is this dangerous?
What is standard crininine level for a 67 yr. old
male?
What is the BCP cholesterol test?
Hi, Can amas test for cancer ? can you do it?
thanks
30
A pharmacopeia…and the thick PDR
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I am on 1 mg of Primogyna daily…iron tablets, garlic,
gelatin capsules, brewers' yeast…Ginko Biloba and
Noni…Cozaar…Allegra, Nasonex, and Atrovent.
If taking a c-peptide test how would the drugs Amaryl
(glimepiride) & Avandia (Rosiglitazone Maleate) I am
taking for diabetes affect the test?
I am taking eltroxin since 1998…. St.Johns
Wort…Depakote, mebaral… lipitor
31
What could that possibly
be???
O presente texto está na lingua portuguesa (Brasil) e os
 The test is a HRP test. It's either related to my
exames são de minha filha Raquel que apresenta icterícia,
heart disease
or my diabetes.
cefalopatia,
colecistopatia
acalculosa e tem 21 anos de idade
e gozava de perfeita saúde. Não consome alcool ou outra
droga
qualquer, exceto um remedio recomendado pela
 What is a gamma test? I have results but I don’t
dermatologista de nome Flutamida. Eu ficaria muito grato
know what it is for. Is there a charge for this
com suas explicações para os resultados dos exames que
service,
if so please disregard my message, thank
transcrevi
abaixo:
you. direta 7,10 mg/dl; Bilirrubina indireta 4,90 mg/dl;
Bilirrubina
Bilirrubina total 12,99 mg/dl
Material: sangu; Método: Jendrassik mod.

My 77-year-old father has been asked to have a
"12/60 creatinine"http://www.altavista.com
test.
32
Do they really mean that?
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What is the significance of elevated nitrates in the urine?
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I had a test to determine my blood glucose level since I have type 2
adult onset diabetes… hemoglobin A1c 5.6… I was expecting a
reading similar to the blood test results that I get daily on my
glucometer. How can I interpret the lab results? Thank you.

I am interesting to know the test for cinetic creatinine concernig to
eliminate the cromogenous
33
…you’re thinking of doing what?
We are exploring this test in our ED. I am interested
in getting information on the technique used to
perform the test (I know the sample is placed in a
cartridge which is placed in a portable meter—
what I don’t know is whether the reading is by
mass spectrometry, electrophoresis, or some
other technique). Do you have any information?
Thanks in advance for any assistance you can
provide.
34
Interpreting laboratory jargon
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Subject: Urine culture
What does mixed urogenital flora, less than
10,000 colonies/mL effect the test results?
35
Uh Oh!
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During an annual exam my docter advised me
that I may be infected with chlamydia. I have
been completely faithful to my boyfriend of three
years, and have never had an issue with previous
exams. Could I still have gotton this if my
boyfriend has been faithful to me? I have heard
that in some cases an STD can go undetected for
some time is this true?
I know that Trich is a STD but what causes it
exactly? Also who gets it first a man or a
woman?
36
Questions from physicians
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Question: Patient was
screened for HepB as part
of pregnancy blood
testing. No known risk
factors.
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Wife Results Oct/04
HepB-HBsAg
positive
HepB-HBeAg
non reactive
HepB-Anti-HBe reactive
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What do you think?
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Given results below were the
husband and wife ever exposed
to HepB, are they currently
infectious (acute/carrier), is
further testing required?
Wife Retest Results Nov/04
HepA-AB(IgG+IgM)
Negative
HepB core IgM AB
Negative
HepBs Antibody <10 Nonimmune
Wife Second Retest Nov/04
HepBs Antibody <10 Nonimmune
Husbands results Nov/04
Surface Antibody (Anti-HBs) <2.0
Liver Markers Normal
Antibody (Anti-HAV) Not detected
37
HIV serology
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Hi - I would just like to know what the
numbers mean on my negative HIV
test results. My print out is as follows
for 4 tests since May 2004.
May 2004

AxSym HIV 0.30
HIVNG
Jul 2004
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AxSym HIV 0.29
HIVNG
Oct 2004
AxSym HIV 0.40
HIVNG
April 2005
AxSym HIV 0.30
HIVNG
Test - AxSYM HIV 1/2 Ag/Ab MEIA
What are these numbers
(ie. 0.30 etc) and why do
they change?
If I am HIV Neg why is
there a reading at all?
This is very confusing and
I asked the nurse at the
clinic where I got the
results who said “the
number is just something
to do with the type of
test” but to me it seems
to be some kind of
measurement???
38
Obsessed by HIV
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hi ascls,this is me again…there is something i still cant
get convinced enough about the blood circulation of the
eyes..well, does the blood from the eyes flow thru down
the body..? but i just wonder does blood in the capillaries
of the eyes flow back to the body..? this question is
crucial to me as im afraid hiv virus might get into the
eyes as for my past encounter of the semen gettin to my
eyes..
(And then, 7 e-mails later)…i recently had a couple of
dust particle from my shoe went into my coke
drink…..will i get any hiv disease drinking that lot of dust
in the drink or pose any danger to my health?
39
Why me?
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I have bugs-yes bugs- in my urine. I noticed in the
toilet little things floating & upon closer inspection
with magnifying glass there were lots...of them
swimming. I went to my doctor who did a urine test,
said
I had infection & gave me 30 cephalexin caps. I've
taken all of them which has been 10 days but I still
see some bugs & lots & lots of eggs in all different
stages of development.
I think the bugs I pass now are not alive
but why are there still so many eggs
& when will they be gone?
40
Immunology
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Typical questions include
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ANA:
My ANA came back positive. the Titer
was 1:320 and speckled what does this
mean?
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RF or RA:
I had been tested for RA 6 years ago. I have
my medical records and I don't know how to
read it. What test would hev been ordered
and how is it abbreviated? Also what would
the test results look like? Lab test ordered
under what heading would I find the info?
thanks very much
41
Other Questions
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am a 49 y/o female, my lab results are the
following:
complement component
C3.......mg/dl........130.03
complement component
C4.......mg/dl..........10.71
are these within the normal range
Is this (antiphospholipids) the same as
anticardiolipin antibodies?
42
Some Questions Are
Different...

Can you tell me how many serological
celiac tests are done annually in the
US? Thank you.
43
And My Personal Favorite
Question
Can you get pregnant from
oral sex?
44
And there are times we’d
rather not know…

I am a 17 year old male and i have a 2 inch
penis. I am emailing you to find out will my penis
grow any more. If no, is there some type of
medication (that works) and is to increase my
penis. It is kind of embarrising not to have a
girlfriend or take a shower at school.
45
Truly legal implications
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How does one test for the presence of
semen in a sample of womans
underware? I have several samples I
have collected, but don’t know what to
do with them. Please help. Thank you.
46
Unique outside research
needed to answer some…

do you think that if doc ock used amylase and
starch hydrolysis he could defeat spider man?
(listed as a “health care provider”!)
…then there’s always back to
square one…

what does protective mean on the
green level
47
And what do our healthcare
colleagues ask?
 I am a pharmacist and would like to
know what electrolytes testing tells a
doctor. Also, is there a web site that
would tell tell me what lab testing
reveals to a doctor? What is so
important about a relation between
Sodium and Potassium?
48
And what do our healthcare
colleagues ask?
 I am a physician. What are the
effects/consequences of pancreas
removal?

As a nurse, I am curious if you can tell
the difference between inherited and
acquired osmotic fragility?
49
Time to challenge the
clinician!

I am 28 years old from the philippines. I had this bad
headache at the back of my head. It‘’s agonizing. for
almost a month its attacking once in a while but
lately more thank a week now the headache is
getting worst. So, i had an ESR test and it say there
the normal range is 0-20 but my result is 40. But
the doctor ask my age and I said 28 and he
added 14 into it that makes it normal he said.
so, am not really sure if what he said is correct. so,
pls. let me know so they're be light into this matter.
50
Other resources
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Join the consumer webpage information
team!
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Immediate access to thousands of
questions saved by other team members
Incredible experience… definitely making a
difference in the lives of patients
Great role model for your students!
Possible book?
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Other resources
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Student responses
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I enjoyed going over the questions from the
consumer webpage. It really helped me not only to
increase my knowledge of clinical chemistry, but also
to see another side of being a Clinical Laboratory
Professional. It reinforced that we need to be able to
communicate with patients as well.
Discussing the questions from the consumer
webpage forced me to understand the material more
and be able to communicate that knowledge to
patients….definitely a critical thinking experience.
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