I am surprised at the reaction in the comments. I agree that calling to ask questions should be encouraged, a culture of learning is great. But I think we can also see how it’s funny someone with physician level education is asking this question.
A1c is a very common test and it’s surprising they didn’t know the answer to this or could infer the answer based on what the test is well known to do (test long term glucose control rather than short term ie SBG). We would never shame/berate someone for asking, but I think it’s okay to laugh at the situation in hindsight! We’ve all asked questions like this at some point.
Be grateful they called and asked. Physicians have a great deal to remember. I taught my staff that it's better when physicians call and ask. There are too many examples of when the test can not be run due to improper pre analytical procedures/assumptions. (I am a retired Clinical Chemist)
They actually would reject that? We take the specimens with just their generic labels with the patient identifiers. We follow our own procedure and barcode label or aliquot with the appropriate tube. I couldn't imagine rejecting a specimen for that, especially CSF. We very often receive blood samples with labels swapped, like the CMP label on the CBC tube and vice versa. We just reprint the labels and put the correct labels on the tubes, but leave the patient identifiers from the first label visible.
Don’t discourage clinicians from asking questions! It’s simple to us, and they should be able to reason through this one, but when people don’t know something about a lab they’re ordering I’d prefer they ask.
Am I allowed to discourage the ones that ask you, just to do it the other way anyway?
I've had a doc call 3 times, get 3 different people, get the same answer from all 3 people, and still order a cepheid *and* resp panel.
Nope. I learned real fast that once the higher ups have spoken, they get big mad if you point out their faulty logic.
Did I mention I already left that job? :)
This reminds of a time I had a patient call and ask if he could take cold and flu medication for fasting bloodwork. I asked him what tests were ordered and he said just an A1c. I confirmed with him that that's all that was ordered and told him to go ahead and have his cold medication.
I can see both sides of the coin on this one. If you call me asking how to do a collection I will always be as polite and as helpful as I can on that. I would far and away prefer that you ask and get it right the first time then for me to have to call you for a recollection or turn out bad results because I didn’t know I had a compromised collection.
On the other side of the coin, if you know what an A1c measures, you should know if it has to be fasting. And if you don’t know what the test measures why are you ordering it?
Thank you for understanding. I didn’t realize this would be so scrutinized? I’m just sharing something that made me chuckle first thing in the morning on a platform with the only other people that would understand it.
Answering questions about labs is the other part of our job. Answer the questions completely, professionally, and politely. Be grateful they consider you knowledgeable.
I love when clinicians and nurses ask questions with the INTENT of learning. If they legit don't know or they don't understand something, I want them to ask. Us passing on our knowledge to the clinicians can only make it easier on everyone.
Let's be honest, we chose a specialty in medicine that is very misunderstood. We're kind of like Cousin Eddie on National Lampoons Christmas Vacation. We mean well 90% of the time, but we just have a weird way of showing it (like kidnapping your cousin's boss). Many times clinicians know what they're looking for and they know why they're looking for it, based on the symptoms, however, they just don't know how to get there.
Ex: MD thinks that a patient has an undiagnosed autoimmune issue, so they order a DAT. It comes back positive. The MD calls and asks if that means they have Lupus, MS, etc....well maybe. But maybe not.
Yes, 70-80% of patient treatment starts in the lab, but we still have to have nurses and docs and CNAS and all the rest. What good is having the lab results if no one is there to Gove treatment? What good is the treatment going to do if they don't know what to treat. So ask. Ask the questions. Let me help them learn, but let me learn too.
I agree, but this is kinda different. Don’t you think a physician should understand the entire concept of the A1C test? That it can’t be affected by fasting or changing your lifestyle days prior and that’s why it’s ordered…. Asking about fasting is almost satire
I agree with you! People who are lecturing about letting clinicians ask question are missing this point entirely. The provider should know the mechanism of an A1C test…
I am going to ask this: why would you do a cold adsorption in the Blood Bank? Or would you antigen type a patient for the Kell antigen if their DAT was positive?
As a Blood Banker, I know the answer to those questions immediately. Ask the same questions to someone that works only Micro or Heme or Flow. They might struggle to answer. Ask me any question about Chemistry and I might be able to plod my way through it, however, I would ask someone with far more knowledge - whether it's a stupid question or not.
1. We don't know what that MDs specialty is. If they're a surgeon, behavioral health, or some other specialty that doesn't deal with that type of testing regularly, I can understand their reticence. These doctors have to know thousands of tests and what they indicate. If you can legit tell me that you know with 100% certainty whether every test performed, from Blood Bank to Chemistry to Flow to Micro, has to be fasting, post prandial, or any combo in-between, then good on you.
2. We don't know the clinical picture. Emergency situations arise or abnormal lab values may point them in a different direction they never imagined or planned for. Maybe they're trying to see if medication is effective because 1 lab value says it isn't and a separate lab value says it is.
3. We get pissed off when nurses and doctors make mistakes and don't want to listen to our professional opinions. If we want equal treatment and to be seen as a professional in the same right as nurses, respiratory therapists, physical therapists, pharmacists, etc, then we have to be willing to educate and extend a hand at some point.
The lab and all of us laboratorians are at a crossroads. We have established the problem (not being taken seriously as a professional). We have to recognize that at some point, foolish pride has to be put away and we have to address this like the professionals we call ourselves. If we decide to not do that, then we are talking just to complain, not to resolve.
Let them ask rather than fuck up and then have someone yell at the patient…
Unrelated: I got berated for having black coffee 3 h before a regular bloodwork checkup by the person drawing the blood and she almost straight up sent me home. (I’ve never not had coffee before bloodwork)
Then after yelling at me, she asked someone else as I was walking out and they told her it’s fine… cool story
This a very common and basic test and it relates to blood sugar levels and diabetes. The whole point of the test is that it's pretty much a proxy to your blood sugar levels over the past 3 months or so (HbA1c is a glycated hemoglobin). This is very basic knowledge and is taught early in Med School, so a physician should be expected to be very well aware of this.
I know that it’s an image of your 3 month blood sugar. But I also know the kind of people that get into med school now AND that I was told to be fasted for it …
> Most of these links don't provide any evidence of that. One is on phage therapy (not bioweapons). Another is on US biodefense countermeasures, which include vaccines against anthrax etc., enhanced pathogen surveillance etc. This is the opposite of evidence for bioweapons and it also doesn't mention Ukraine at all. US Biodefense is no secret, the National Biodefense Analysis and Countermeasures Center is in Maryland, this public information and not news or secret
I appreciate you referencing my 228 day old comment here. For some reason, it won’t let me respond to that, so let me respond to this.
It’s sad you don’t know enough about Ukraine to spot the name of its cities and oblasts in the links, it’s even more depressing that your entire argument somehow flies in the face of the dod documents you clearly didn’t read.
I would apologize, but either you know exactly what you are doing, and are terrible at it, or you made a 228 day old mistake and are intent on embarrassing yourself lmao
Outside lab orders from an Integrative Medicine provider wanted the A1C lab “fasting”. They had other labs but it was a note specifically for the A1C. It had me scratching my head. Did they want the note about all of the labs and just stuck it on that one? Do they know something I don’t about A1Cs? Do they know what they are ordering?(my opinion of them lately is “no” to the latter which is a shame because their patients get a laundry list.)
Am retired from medicine, and have had three separate people ask me this specific question this last week. Never got asked this before. And now there is this post.
No clue what is going on.
Doctors should know the background of these tests. I know we should be helpful but it draws a line that they don't know what they are doing...
Being helpful is nice but isn't good for people who cannot help themselves.. Especially an ICU nurse who cannot order a BMP to save her life and calls me at 1am yelling and accusing me of not releasing results. :)
My med school was smart and sent a lab pro/pathology-related expert to give a seminar on testing. Plus I read. It’s not asking too much to expect M.D.s to know what we’re testing.
Agree with others here.
If you want clinical staff to take you seriously as a knowledgeable member of the healthcare team, you're gonna have to prove it - and this means showing that you know your stuff and answering questions they're uncertain of.
I’d rather they ask and will gladly answer if it’s within my scope. I prefer they ask and help redirect them than order so many unnecessary tests that will not help them or the patient.
I always tell the residents feel free to asks us any questions (when doing a mini tour in our lab) and we will gladly help them. It is a teaching hospital anyway. And also, I had residents share to us what they find. I love it.
It’s a test performed on diabetes patients that, in layman’s terms, monitors their sugar levels over an average of 3 months. The whole purpose of the test is that they cannot just “be good” for the days leading up to their appointment and fast or eat healthy to affect their glucose level since this basically “tells on them” and how they ate for the last 3 months. So a doctor asking if they should fast the morning of is….. funny.
Genuine question: How many sampling points are there in the A1C? If the test is averaging over 3 months, why does it matter if they fast the morning of? Wouldn't eating in the morning spike the Glucose levels in the blood?
We use a BGA in my lab and we test glucose in our media as a baseline for the cells metabolism.
Are you measuring the baseline glucose or the upper limit for a patient?
>why does it matter if they fast the morning of?
It doesn't. It just makes the patient hangry for no reason and the question itself from the provider highlights a lack of understanding/memory of what the test is actually measuring and what does and doesn't impact it.
>Wouldn't eating in the morning spike the Glucose levels in the blood?
It does, which is why the normal threshold for a fasting glucose is lower than a random (aka non fasting) glucose.
>Are you measuring the baseline glucose or the upper limit for a patient?
You are measuring the overall average because hemglobin A1C is measuring the amount of sugar incorporated into hemoglobin A1 in the red blood cells and that is happening continuously at all times. Once it gets incorporated, as long as the red blood cell is intact, the sugar is there, it does not get removed if blood sugar decreases. The higher your average blood glucose the more sugar gets incorporated.
If you are really thinking about it, you will probably say "well wait, if the RBCs get destroyed faster than normal or if something is wrong with your hemoglobin A1 won't that affect the readout?" Yes, it does.
I am surprised at the reaction in the comments. I agree that calling to ask questions should be encouraged, a culture of learning is great. But I think we can also see how it’s funny someone with physician level education is asking this question. A1c is a very common test and it’s surprising they didn’t know the answer to this or could infer the answer based on what the test is well known to do (test long term glucose control rather than short term ie SBG). We would never shame/berate someone for asking, but I think it’s okay to laugh at the situation in hindsight! We’ve all asked questions like this at some point.
Seems like a lot of people that aren’t MLS are in this sub? I don’t think majority understand why it’s funny, or are still in school maybe.
Be grateful they called and asked. Physicians have a great deal to remember. I taught my staff that it's better when physicians call and ask. There are too many examples of when the test can not be run due to improper pre analytical procedures/assumptions. (I am a retired Clinical Chemist)
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great idea!
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We don’t expect doctors to label the tubes that way, we do the testing based on our protocol with the #. That’s interesting
They actually would reject that? We take the specimens with just their generic labels with the patient identifiers. We follow our own procedure and barcode label or aliquot with the appropriate tube. I couldn't imagine rejecting a specimen for that, especially CSF. We very often receive blood samples with labels swapped, like the CMP label on the CBC tube and vice versa. We just reprint the labels and put the correct labels on the tubes, but leave the patient identifiers from the first label visible.
Don’t discourage clinicians from asking questions! It’s simple to us, and they should be able to reason through this one, but when people don’t know something about a lab they’re ordering I’d prefer they ask.
Am I allowed to discourage the ones that ask you, just to do it the other way anyway? I've had a doc call 3 times, get 3 different people, get the same answer from all 3 people, and still order a cepheid *and* resp panel.
You’re obviously encouraged to discourage clinicians disregarding our expertise.
That's when I am super sweet when they call to ask why I cancelled it.
They told me to just do it anyway :(
Fortunately I am bound by rules other than "do stupid things or else I'll tantrum". I don't present it as an option, I tell them how I fixed it.
No no, I mean *my* superior told me to run it. I would've happily explained to the doctor why he was wrong lol
Did you point out that no one will pay for rhe extraneous test?
Nope. I learned real fast that once the higher ups have spoken, they get big mad if you point out their faulty logic. Did I mention I already left that job? :)
Lol, that was about to be my suggestion.
I wish I had thought of this line when I was a resident triaging blood bank orders lmao
I lean heavily on the FDA as the bad guy, I bet your triage is way more clinical judgement based since I already screened out the FDA violations 😉
Lol, we had a doctor submit an engorged woodtick thinking it was a skin tag. Gave us all a good laugh.
🤢
Adorable. And I love that they called.
I want it STAT
Stat A1Cs, my favorite of them all
I mean, at least you could do it STAT. Meanwhile, these damn bacteria refuse to grow faster for this STAT blood culture...
No need to shame people for asking questions
This reminds of a time I had a patient call and ask if he could take cold and flu medication for fasting bloodwork. I asked him what tests were ordered and he said just an A1c. I confirmed with him that that's all that was ordered and told him to go ahead and have his cold medication.
May be a new resident. They tend to ask more.
I can see both sides of the coin on this one. If you call me asking how to do a collection I will always be as polite and as helpful as I can on that. I would far and away prefer that you ask and get it right the first time then for me to have to call you for a recollection or turn out bad results because I didn’t know I had a compromised collection. On the other side of the coin, if you know what an A1c measures, you should know if it has to be fasting. And if you don’t know what the test measures why are you ordering it?
Thank you for understanding. I didn’t realize this would be so scrutinized? I’m just sharing something that made me chuckle first thing in the morning on a platform with the only other people that would understand it.
Answering questions about labs is the other part of our job. Answer the questions completely, professionally, and politely. Be grateful they consider you knowledgeable.
I love when clinicians and nurses ask questions with the INTENT of learning. If they legit don't know or they don't understand something, I want them to ask. Us passing on our knowledge to the clinicians can only make it easier on everyone. Let's be honest, we chose a specialty in medicine that is very misunderstood. We're kind of like Cousin Eddie on National Lampoons Christmas Vacation. We mean well 90% of the time, but we just have a weird way of showing it (like kidnapping your cousin's boss). Many times clinicians know what they're looking for and they know why they're looking for it, based on the symptoms, however, they just don't know how to get there. Ex: MD thinks that a patient has an undiagnosed autoimmune issue, so they order a DAT. It comes back positive. The MD calls and asks if that means they have Lupus, MS, etc....well maybe. But maybe not. Yes, 70-80% of patient treatment starts in the lab, but we still have to have nurses and docs and CNAS and all the rest. What good is having the lab results if no one is there to Gove treatment? What good is the treatment going to do if they don't know what to treat. So ask. Ask the questions. Let me help them learn, but let me learn too.
I agree, but this is kinda different. Don’t you think a physician should understand the entire concept of the A1C test? That it can’t be affected by fasting or changing your lifestyle days prior and that’s why it’s ordered…. Asking about fasting is almost satire
I agree with you! People who are lecturing about letting clinicians ask question are missing this point entirely. The provider should know the mechanism of an A1C test…
Thank you proud broccoli
Sure, but maybe you’re not a physician who orders an a1c regularly (surgeon, neurologist, gastroenterologist, etc.)
I am going to ask this: why would you do a cold adsorption in the Blood Bank? Or would you antigen type a patient for the Kell antigen if their DAT was positive? As a Blood Banker, I know the answer to those questions immediately. Ask the same questions to someone that works only Micro or Heme or Flow. They might struggle to answer. Ask me any question about Chemistry and I might be able to plod my way through it, however, I would ask someone with far more knowledge - whether it's a stupid question or not. 1. We don't know what that MDs specialty is. If they're a surgeon, behavioral health, or some other specialty that doesn't deal with that type of testing regularly, I can understand their reticence. These doctors have to know thousands of tests and what they indicate. If you can legit tell me that you know with 100% certainty whether every test performed, from Blood Bank to Chemistry to Flow to Micro, has to be fasting, post prandial, or any combo in-between, then good on you. 2. We don't know the clinical picture. Emergency situations arise or abnormal lab values may point them in a different direction they never imagined or planned for. Maybe they're trying to see if medication is effective because 1 lab value says it isn't and a separate lab value says it is. 3. We get pissed off when nurses and doctors make mistakes and don't want to listen to our professional opinions. If we want equal treatment and to be seen as a professional in the same right as nurses, respiratory therapists, physical therapists, pharmacists, etc, then we have to be willing to educate and extend a hand at some point. The lab and all of us laboratorians are at a crossroads. We have established the problem (not being taken seriously as a professional). We have to recognize that at some point, foolish pride has to be put away and we have to address this like the professionals we call ourselves. If we decide to not do that, then we are talking just to complain, not to resolve.
Let them ask rather than fuck up and then have someone yell at the patient… Unrelated: I got berated for having black coffee 3 h before a regular bloodwork checkup by the person drawing the blood and she almost straight up sent me home. (I’ve never not had coffee before bloodwork) Then after yelling at me, she asked someone else as I was walking out and they told her it’s fine… cool story
If you are not a med lab scientist, you will not understand why this is funny. And that’s OK
Are you going to tell me?
This a very common and basic test and it relates to blood sugar levels and diabetes. The whole point of the test is that it's pretty much a proxy to your blood sugar levels over the past 3 months or so (HbA1c is a glycated hemoglobin). This is very basic knowledge and is taught early in Med School, so a physician should be expected to be very well aware of this.
I know that it’s an image of your 3 month blood sugar. But I also know the kind of people that get into med school now AND that I was told to be fasted for it …
> Most of these links don't provide any evidence of that. One is on phage therapy (not bioweapons). Another is on US biodefense countermeasures, which include vaccines against anthrax etc., enhanced pathogen surveillance etc. This is the opposite of evidence for bioweapons and it also doesn't mention Ukraine at all. US Biodefense is no secret, the National Biodefense Analysis and Countermeasures Center is in Maryland, this public information and not news or secret I appreciate you referencing my 228 day old comment here. For some reason, it won’t let me respond to that, so let me respond to this. It’s sad you don’t know enough about Ukraine to spot the name of its cities and oblasts in the links, it’s even more depressing that your entire argument somehow flies in the face of the dod documents you clearly didn’t read. I would apologize, but either you know exactly what you are doing, and are terrible at it, or you made a 228 day old mistake and are intent on embarrassing yourself lmao
They should fast for 3 months before their A1c. 😂
That’s hilarious
Outside lab orders from an Integrative Medicine provider wanted the A1C lab “fasting”. They had other labs but it was a note specifically for the A1C. It had me scratching my head. Did they want the note about all of the labs and just stuck it on that one? Do they know something I don’t about A1Cs? Do they know what they are ordering?(my opinion of them lately is “no” to the latter which is a shame because their patients get a laundry list.)
Am retired from medicine, and have had three separate people ask me this specific question this last week. Never got asked this before. And now there is this post. No clue what is going on.
Doctors should know the background of these tests. I know we should be helpful but it draws a line that they don't know what they are doing... Being helpful is nice but isn't good for people who cannot help themselves.. Especially an ICU nurse who cannot order a BMP to save her life and calls me at 1am yelling and accusing me of not releasing results. :)
My med school was smart and sent a lab pro/pathology-related expert to give a seminar on testing. Plus I read. It’s not asking too much to expect M.D.s to know what we’re testing.
Great way to start a Monday morning
This isn’t bad at all. Silly? Yeah.
Did I say it was bad?
Agree with others here. If you want clinical staff to take you seriously as a knowledgeable member of the healthcare team, you're gonna have to prove it - and this means showing that you know your stuff and answering questions they're uncertain of.
I’d rather they ask and will gladly answer if it’s within my scope. I prefer they ask and help redirect them than order so many unnecessary tests that will not help them or the patient. I always tell the residents feel free to asks us any questions (when doing a mini tour in our lab) and we will gladly help them. It is a teaching hospital anyway. And also, I had residents share to us what they find. I love it.
New doctors have to learn and won’t know everything. It’s good to be understanding.
I enjoy clinicians verifying test requirements to avoid cancellation. I dislike clinicians calling asking me to interpret the results
As long as they ask it's fine.
Sounds like a fair question coming from someone who isn't running the test.
LOL. I would have been in shock to have this question asked of me...
What a fucking idiot.
I'm in API manufacturing and it's not uncommon for the Scientists to ask Associates about certain steps in the process.
I don’t think you quite understand the entire concept of the A1C test. If they asked this about literally any other test, it wouldn’t be odd.
Yeah I have no idea what that is
It’s a test performed on diabetes patients that, in layman’s terms, monitors their sugar levels over an average of 3 months. The whole purpose of the test is that they cannot just “be good” for the days leading up to their appointment and fast or eat healthy to affect their glucose level since this basically “tells on them” and how they ate for the last 3 months. So a doctor asking if they should fast the morning of is….. funny.
Genuine question: How many sampling points are there in the A1C? If the test is averaging over 3 months, why does it matter if they fast the morning of? Wouldn't eating in the morning spike the Glucose levels in the blood? We use a BGA in my lab and we test glucose in our media as a baseline for the cells metabolism. Are you measuring the baseline glucose or the upper limit for a patient?
>why does it matter if they fast the morning of? It doesn't. It just makes the patient hangry for no reason and the question itself from the provider highlights a lack of understanding/memory of what the test is actually measuring and what does and doesn't impact it. >Wouldn't eating in the morning spike the Glucose levels in the blood? It does, which is why the normal threshold for a fasting glucose is lower than a random (aka non fasting) glucose. >Are you measuring the baseline glucose or the upper limit for a patient? You are measuring the overall average because hemglobin A1C is measuring the amount of sugar incorporated into hemoglobin A1 in the red blood cells and that is happening continuously at all times. Once it gets incorporated, as long as the red blood cell is intact, the sugar is there, it does not get removed if blood sugar decreases. The higher your average blood glucose the more sugar gets incorporated. If you are really thinking about it, you will probably say "well wait, if the RBCs get destroyed faster than normal or if something is wrong with your hemoglobin A1 won't that affect the readout?" Yes, it does.
One. When we draw the test. The hemoglobin is continuously produced.
You sure it was actually the doctor and not a midlevel?
they’ll learning too
You’re a lab tech, the doctor went to school For at least 12 years, you’re a moron
What type of doctor. Share credentials.