Blood Tests - Why Do We Do Them?

Raised Inflammatory Markers - Yesterday when I was on-call I was reviewing the blood results from a patient and noticed that CRP (C-reactive protein, a commonly tested inflammatory marker in the hospital setting) was suddenly elevated. Why was this? Why do we do a CRP test on so many patients in hospital on a near daily basis? I then saw this article which answered a few questions:

Normal levels of inflammatory markers are useful for ruling out a few specific conditions, such as giant cell arteritis. They are also useful for monitoring treatment to disease. So what to do with a suddenly elevated CRP? CRP is particularly useful in identifying bacterial infection. According to this article, if the history and examination yeild no clue as to cause, it would be sensible to do nothing and wait to see if symptoms develop. Incidental abnormalities can lead to unnecessary and potentially harmful investigations. This is supported by follow-up studies in asymptomatic patients with incidental findings of raised inflammatory markers over a six year period.

Hand-Washing Compliance - I was sent an email with a copy of a letter from the Scottish Health Secretary Nicola Sturgeon this week with an update on hand-hygeine compliance. Apparently doctors have a consistently lower hand hygiene compliance rate than other staff groups in the hospital settings. The question I wondered about this was why? Is there a reason for this and what can be done about it?

Disappointing for Scotland this weekend!

The Running GP - This was an article on the BBC News website which was also printed in this week's BMA News. A GP based in Edinburgh with a passion for long-distance running ran from John O'Groats to the Sahara desert in 77 days and has been appointed by the Scottish Government to promote physical exercise. He states that according to research having a low physical activity level is equivalent in risk to health to smoking, having diabetes and being obese all combined. I don't think we give patients enough advice on physical activity and it certainly doesn't feature on routine hospital 'clerk-ins' whereas alcohol, smoking and BMI do. Perhaps we should be asking all physically able patients on admission to hospital what their levels of physical activity are. I fear that in Glasgow the standard is pretty low.

Vital Signs + Abbreviations - I read a letter to the BMJ this week from a GP who complains about the use of abbreviatons in discharge summaries sent to GPs. One particular script had the abbreviation 'MIRO'. The GP phoned the consultant, who had no idea. The consultant then asked the FY1, who said it stood for 'myocardial infarction ruled out'. Embarrasing for the FY1 and a fair reminder about the dangers of using abbreviations which can widen the communication gap between primary and secondary care.

Consultant Feedback - Finally, a junior doctor in London writes in about the '360 feedback' which doctors are required to fill out every 4 months, where at least 2 respondents must be consultants. At first I thought this was going to be a moan about feedback but actually he makes the point - when do the juniors get the opportunity to feed back to the consultants? Perhaps junior doctors should become involved in feedback about consultants from time to time - I think this sounds reasonable!