General Information
       
Coping with Test Pain, Discomfort and Anxiety    
Reference Ranges and What They Mean    
Quality Assurance and Quality Control Monitored at Each Step    
 
A. Coping with Test Pain, Discomfort and Anxiety
 
Nobody particularly enjoys having blood drawn or providing a urine or stool sample, but a medical test conducted on a small sample collected from your body can give your doctor information that can help save or improve the quality of your life. Most people get through their medical tests just fine even though they may feel some embarrassment, discomfort, or anxiety at the outset. If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, read this for some general tips on how to make the sample collection experience more positive and less stressful.
 
Know What to Expect
Your physician uses medical tests to help ensure accurate and timely diagnosis of conditions that could seriously affect your health. Tests also help your physician monitor your therapy. As bothersome as it may seem to undergo the testing, the good news is that the tests in use today are more accurate and useful than ever. They also tend to be significantly less intrusive.

Sometimes, undergoing an unfamiliar medical procedure can turn out to be a tense, upsetting, or even frightening experience. With a little preparation, however, you can help ensure that your lab test is as quick, painless, and accurate as possible. Emotional distress is more likely when your experience with a medical procedure does not match your expectations. Knowing what will happen is a good way to maintain composure.

Understanding why a medical test has been ordered can improve your attitude and preparation for the test. Being well prepared also helps you feel more relaxed and in control of the situation. Ask your physician to explain the reasons for your test and how the test will be conducted.
 
Understanding Your Tests

When a test is ordered for you, you should find out why the test needs to be done, how it will be done, and what the physician expects to learn from it. Here are some good questions to ask:

  • Why does this test need to be done? How could it change the course of my care?
  • What do I need to know or do before the test?
  • What happens during and after the test?
  • How much will the test hurt or be an inconvenience? What are its risks?
  • How long will the test take? When will results be available?
  • Where do you need to go to take the test? Is there a "good" time to schedule the test?
  • What are normal results? What do abnormal results mean?
  • What factors may affect the results?
  • What course of action may be next, after the test?

Your doctor or nurse is the best person to look to for answers. No matter how brief the answers may be, asking your physician, physician's assistant, or nurse is likely to provide you with the answer most specific to your situation. Of course, time constraints, your comfort in asking questions of your doctor, and simply forgetting to ask the important questions will sometimes compel many patients to look elsewhere for this information. Fortunately, there are many other sources to turn to.

The medical technologist or laboratory technician can answer questions about how the sample is collected; this person may not, however, have the knowledge to fully answer your questions about what the test is for, how results are interpreted, and what happens next.

Other information sources, such as this web site, are available online, as are a number of free services. If you are aware of other similar online resources, please let us know at dishapathology@vsnl.net so that we might offer the links to others.
 
Relaxation Techniques

Knowing a few simple relaxation and focusing techniques can help you avoid tensing your muscles or becoming faint during any difficult medical procedure. Although the medical staffs performing these procedures is usually good at making small talk and creating distractions that take your mind off your discomfort, you can also soothe yourself or an anxious patient with the following techniques. If you are anxious about medical tests and need them frequently, you will find it helpful to practice these skills at home to make them even more effective when you need them

  • Breathe - Take three slow breaths, counting to three for each one and breathing through your nose. Breathe out through your mouth, counting to six. Push your stomach out as you breathe in (to breathe more deeply). Slow down if you start to feel lightheaded.
  • Relax Your Muscles - Consciously relax your muscles. Let them feel loose.
  • Focus - Find a focal point to look at or envision a pleasing image.
  • Count - Count slowly and silently to ten.
  • Talk -Chat  with someone in the room. The distraction can relax you
That Wasn't So Bad Now, Was It?
Many of the tests your doctor orders for you today are less intrusive and more comfortable than the older, less accurate tests they have replaced.

A variety of specimen collection equipment has also been designed with patient comfort in mind.

Don't hesitate to request a modification or a different approach that better suits your needs. You can expect that the health professionals responsible for collecting the sample have been trained to be sensitive to the needs of apprehensive patients and people with special needs. They have some proven strategies to help you and are usually willing to listen to you to determine what will work best in a situation.

Understanding what will happen, communicating your needs to the health care professionals assisting you, employing simple relaxation techniques, and knowing how to take care of any minor physical pains will help the apprehensive individual be most comfortable and prepared for a medical test. Now, the next time your doctor orders some "routine tests," you can take comfort in knowing the routine.

 
B. Reference Ranges and What They Mean
 
Test results are usually interpreted based on their relation to a reference range.
 
The "Normal" or Reference Range
 
"Your test was out of the normal range," your doctor says to you, handing you a sheet of paper with a set of test results, numbers on a page. Your heart starts to race in fear that you are really sick. But what does this statement mean, "Out of the normal range"? Is it cause for concern? The brief answer is that a result out of the normal range is a signal that further investigation is needed.

The interpretation of any clinical laboratory test involves an important concept in comparing the patient's results to the test's "reference range." (It's also commonly called the "normal range" but today reference range is considered a more descriptive term.
 
What is a reference range?
Some tests provide a simple yes or no answer.

A typical lab report will have your results followed by a normal or reference range. For example, your results for a thyroid-stimulating hormone (TSH) test might look something like: 2.0 m-IU/L, ref range 0.5 - 5.0 m-IU/L. The test results indicate that it falls within the "normal" range.

How was that reference range established? The short answer is: by testing a large number of healthy people and observing what appears to be "normal" for them.
 
Effects of Age and Sex on the reference range
For many tests, there is no single reference range that applies to everyone because the tests performed may be affected by the age and sex of the patient, as well as many other considerations.

Alkaline phosphatase is an enzyme found in the cells that make bone, so its concentration in the body rises in proportion to new bone cell production. In a child or adolescent, a high alkaline phosphatase level is not only normal but also desirable-the child should be growing healthy bones. But these same levels found in an adult are a sign of trouble-osteoporosis, metastatic bone disease (extra bone growth associated with tumors), or other conditions. So experience from testing large numbers of people has led to different reference ranges by age group.

Hemoglobin and hematocrit (a red blood cell measure) both decline as a natural part of the aging process.

The patient's sex is another important consideration for many tests.

Creatinine is produced as a natural by-product of muscle activity and then removed from your bloodstream by your kidneys. Because males have greater muscle mass than females, the reference range for males is higher than for females.

As another example, blood loss through menstruation may cause lower hemoglobin and hematocrit levels in premenopausal women.
 
Other Factors Affecting Test Results
Laboratories will generally report your test results accompanied by a reference range keyed to your age and sex. Your physician then will still need to interpret the results based on personal knowledge of your particulars, including any medications or herbal remedies you may be taking. Additional factors that can affect your test results include your intake of caffeine, tobacco, alcohol, and vitamin C; your diet (vegetarian vs. non-vegetarian); stress or anxiety; or a pregnancy. Even your posture when the sample is taken can affect some results, as can recent heavy exertion.

It's important to comply with your doctor's instructions in preparing for the test, such as coming in first thing in the morning, before you eat anything, to get your blood drawn. That compliance makes your sample as close as possible to others; it keeps you within the parameters of your reference group.

 
What does it mean if my test result is out of the reference range?
Based on the laws of probability, 1 out of 20 (or 5%) determinations will fall outside the established reference range, thus a single test value may mean nothing significant. Generally, the test value is only slightly higher or lower than the reference range. To put this in more perspective: If a doctor runs 20 different tests on you, there's a good chance that one result will fall out of a reference range despite the fact that you are in good health.

Of course, the result may indicate a problem. The first thing your doctor is likely to do is to re-run the test. Perhaps the analyte being measured happened to be high that day due to one of the reasons stated above, or perhaps something went awry with the sample (the blood specimen was not refrigerated, or the serum was not separated from the red cells, or it was exposed to heat).

Laboratories will generally report the findings based on age and sex, and leave it to the physician to interpret the results based on factors such as diet, your level of activity, or medications you are taking.

If you know of any special circumstances that could affect a test, mention them to your doctor; don't assume your doctor has thought of every possible circumstance.

 
C. Quality Assurance and Quality Control Monitored at Each Step
 
From the moment a test is ordered, attention to detail becomes an issue critical to the quality of your lab results.

To make it easier to see all the points where quality is monitored - and the areas where the quality of your input is important - we have divided the tasks into three main phases:

Pre-Analytical Activities: what happens when the test is ordered and the sample is collected

Analytical Activities: what happens in the lab where the test is conducted

Post-Analytical Activities: what happens between the time the test is run and the results are reported

Reliability of test data is high because attention to quality is paid every step of the way:
Test is ordered --> Sample is collected --> Test is run --> Results are reported

At Disha Pathology Services, we adhere to comprehensive quality assurance programs to create the uniform high quality that makes lab data reliable. While not infallible, each lab's quality control program rigorously defines requirements for staff proficiency, equipment maintenance and monitoring, and other standards of operations.

Pre-Analytic Activities:  Where Quality Originates
From the moment a test is ordered, quality becomes an issue critical to the outcome. Quality assurance procedures extend to the following areas:

  • Test ordering process
  • Specimen collection procedures
  • Transport to the lab
  • Specimen handling and storage
  • Completeness of patient information

Automated ordering systems are increasingly used to minimize errors in sample collection and test requests. Well-organized computer screens allow quick input of test orders, minimizing the chance for misunderstanding and error.

Important: A patient who does not follow preparation instructions or provides insufficient information to the physician undermines the entire quality assurance effort for a specific test.
 
Analytic Activities: Proceeding with Utmost Care

In the lab where the specimen is analyzed, quality assurance procedures guide and monitor all related activities, including the following:

  • Instrument maintenance and operation
  • Test reagents
  • Supplies
  • Personnel
  • Actual test performance

Where procedures can be automated, human error can be minimized. Many test methods use automated analyzers. Most instruments have internal computer systems to detect malfunctions.

 
Post-Analytic Activities: Reporting with Quality

As test results are made available, work quality continues to be monitored in areas such as the following:

  • Report sent to appropriate party
  • Timely reporting of data
  • Reference ranges included
  • Immediate notification of results exceeding "critical limits"
Important Conclusions
 
The Careful Clinician
Laboratory testing is a science professionally conducted with rigorous statistical analysis and quality controls. But medical diagnosis has been called an art, a clinical reasoning process, not always clear cut, which relies on information from multiple sources. Medical testing is an important component in the diagnostic tool kit, and very often an invaluable tool, but it is most reliable when used in conjunction with other meaningful data collected in the diagnostic process.

...and The Careful Patient
You can put great trust in the data generated by today's exacting medical tests. A caveat to remember is that a diagnosis and treatment plan for a serious disease should never be based on a single medical test. Test findings are just one of the pieces of the diagnostic puzzle. Please follow test preparation instructions carefully and tell the person collecting your sample about any exceptions you made.


 
 
 
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