I can only imagine how frustrating it must be waiting for pathology results in the hospital. As a hospitalist I often see patients who have newly diagnosed abnormalities on imaging studies. Masses. Nodules. Enlarged lymph nodes. If there is a visible tissue abnormality on imaging, and the clinical scenario suggests that tissue is the issue, we biopsy. So I find this study from the NYT interesting. Waiting for the pathology results to make the diagnosis can be as stressful as being told you have cancer.
This doesn't surprise me. The anxiety of the unknown can be frightening. The same thing occurs with needle stick anxiety. I was stuck as a resident putting in a central line. It is not a fun experience. Surgeons, I'm sure deal with this all the time.
I understand the anxiety of not knowing. And I always make an effort to get clinical pathology, whether it's histology pathology or cell pathology or surgical pathology or molecular pathology. At the least I try to get preliminary pathology results as quickly as possible by calling the pathologist personally to see what results we can get now.
One problem I run into frequently is a late week biopsy. Perhaps a Thursday or Friday tissue expedition. I"m not sure if pathologists have some sort of national union agreement not to work weekends, but it's darn near impossible to get a tissue sample evaluated and even processed on the Friday-Sunday pathology dead zone.
If you are going to get sick, and you are going to have a mass, hope that you aren't admitted on a Thursday through Sunday. In all likelihood you wont get your biopsy. But if you do, it won't be processed until normal working business hours. I'm not sure there is any way to get pathology results any quicker.
What is your experience as a physician or as a patient?
I'm curious as to how many needle sticks happen at your hospital?
ReplyDeleteI heard the average rate is 1 per hospital per day.
Are there any steps you take to prevent needle sticks?
Had a mammo which showed a cyst; couldn't get an appointment during hours when radiologist was en-suite for four anxiety-filled weeks. Had appointment, dreaded cyst was still there, was ushered into the ultrasound room. After half an hour of cold goo, the radiologist arrives and starts throwing out all the terminology in the radiologists' secret breast imaging babble book. I interrupted him, and politely said, "Excuse me but I don't understand a thing you're saying." (This was not a language gap, rather a terminology gap.) He stopped mid-sentence, looked at me, and said "It's a cyst. That's good.". I apologized for interrupting and thanked him for the explanation. The cyst went away by itself.
ReplyDeleteI'm a pathologist for a large lab that only reads outpatient skin biopsies. If requested, we can run a "RUSH" case on the weekend, but it requires having not just a pathologist come in on the weekend, but also handful of other staff members. We need a histotech to process and prepare the slides to be read. It's hard to get enough techs to work normal hours (we're always short staffed - this is a national shortage) much less weekends. Most hospitals I have worked at have a pathologist on call at night and on the weekends. They can do "frozen sections" quickly, but anything requiring processing takes at least 24 hours plus tech time. A lot of things cannot/should not be frozen as this causes artifact and exhausts tissue for further studies. If your biopsy is difficult (requires special stains or immunoperoxidase stains) it will be delayed even further - all these things take time. I'd rather have the right answer than the quick answer.
ReplyDeleteWalked in these shoes this week. Friend got called back for "extra views" on mammogram. Friend goes nuts, cancels hair appointment because, "all my hair will fall out with chemo anyway." I keep telling her extra views are just to be extra cautious and are good medicine. Friend loses it and sobs in car. Long story short, nothing there that doesn't belong there! Her cortisol level was probably sky high.
ReplyDeleteSigh.
I tried to get her to wear the lens of perspective, but it was no use. Trying to get patients (not just friends!) to calm down once they have the "c" word in mind is darn near impossible.
I once had an enlarged lymph node removed after being told I probably had cancer. The surgeon said it didn't look like normally cancerous tissue. Then found out it was after a day or two.
ReplyDelete6 months later had surgery to remove tumor and surrounding nodes. It took 2 weeks to hear anything and until I heard the good news, I'd convinced myself it was still cancerous.
I wanted to second the pathologist's comment. It is very often not hte pathologist, but rather the ancillary studies that take the time. It is not cost effective to have the full lab staffed with techs 24/7. However, the recs from this study suggested just that. These results are NOT emergencies, in spite of the anxiety. The wait is MUCH worse in other countries - we are actually quite spoiled in the US in terms of health care responsiveness.
ReplyDeleteI was in denial after my path came back Crohn's disease - maybe because I was on high dose steroids?
ReplyDeleteIt took a few days for the truth to "sink in" even though I do the hospital thing every day. Nothing is ever real until it happens to you.
I tell patients "I know what it's like to wait" because I do know (not that it helps any).
Most pts have a good idea when it's something bad.
The waiting is like being strapped down on a table, as you look up at an axe swinging back and forth over you, lowering slightly, while you begin to picture all sorts of things. The imagination can take you to some very dark places.
ReplyDeleteAfter having cancer myself, and just having to go for some testing this week to look again. I can tell you it was so nice to have the radiologist understand and take a look at them right then for me. (I never said a word, and would have waited like anyone else.) Because he did that for me, it took a huge weight off of me. I was able to go on my way without the angst. I made sure to tell the nurse to thank him for me! Even if it had come back suspicious, at least then I would be thinking of what do we do now, if anything. I'd rather know...then wait.
You gotta hear the caveat 'working days' when you ask when things will be back.
ReplyDeleteI, lucky me, don't work on weekends, why should anyone else who can swing it either?
In my experience, if a week has a holiday or school is out you have to figure that half the staff is on vacation or off with their kids, and add a couple more 'working days' to your time expectation.
patologist are like that even before becaming one, my best friend is gonna be pathologist, i know him since med school, and he always says he likes it, cause he like histology and he wont have TO WORK ON WEEKENDS and he wont have TO WORK AT NIGHT.
ReplyDeleteI am going through the occupational exposure to multi-drug resistant HIV thing right now. I don't think my cortisol levels can hold strong for 6 months.
ReplyDelete