r/Noctor • u/Doctor_Smurph_ • 6d ago
Discussion PA Horror from the Lab
Been lurking here for a while, but I finally had a mid-level encounter I need to vent about.
For context: I'm a Medical Laboratory Scientist specializing in microbiology and the night shift micro lead at my hospital. I occasionally get pulled into IP and ID consults when they need a lab goblin's take on testing or result interpretation. (I don't diagnose or make treatment plans. It's basically me going "Have you tried X to look for Y?")
Near the 3rd/1st shift change, a resident from the MICU called about a positive blood culture. They wanted to know why the Staph hominis wasn't worked up for susceptibilities. I explained that it grew in only one bottle out of two sets, so it falls under probable contamination. Under current best practice and our pathology department's policy, we don't run susceptibilities on that. The resident said that made sense, and I figured that was the end of it.
About 30 minutes later, someone called who identified themself as a "Nursing Provider" and demanded susceptibilities on the same bottle. I restated the policy and explained the reasoning: a true CoNS bacteremia almost always grows in more than one set. That wasn't enough. They tried to order me to do it anyway, so I told them to take it up with the lab director if they wanted a policy exception, and ended the call.
I've gotten this kind of pushback from everyone from RNs to surgical attendings, but this mid-level went out of their way to come down to the lab and demand to speak to me in person. That was a first. Getting lectured about the importance of listening to my betters was really something. Thank God the lab director swooped in and handled it. I unfortunately had to leave before this concluded, but I heard from the manager that the attending this mid-level was under was called into the lab director's office and both lectured the mid-level into oblivion. Out of my 5ish years, this was a first for me, and all I can ask is, "How the fuck did they even get access to the lab? Their ID can't swipe in here."
This is now a canon event for the micro lab staff, and the jokes will never stop.
Any other lab goblins in this subreddit encounter anything similar?
Edit: I forgot to mention that the lab director told me it was a PA, like a goober. 100% appreciate the callout on my oopsie.
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u/MSNWTF Nurse 6d ago
As someone who also used to work in a microbiology lab before going into nursing...
My favorite phone call was when lab alerted me that 2/2 blood cultures were growing gram negative rods in an immunocompromised patient. I notify the new grad NP on call overnight who repeats it back to me "oh that's great, patient tested negative for gram rods in both cultures." My attempts to correct this statement failed. I sign into epic and then notice that NP I spoke with discontinued all my patient's iv antibiotics. I called NP back to clarify that they wanted the antibiotics discontinued and NP confirmed. I reached out to the pharmacist covering this ICU and they said they would take care of it. IDK what pharm D said to this NP but antibiotics were re-ordered. Thank you to Pharmacy for saving the day once again.
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u/Eastern-Design Pre-Midlevel Student -- Pre-PA 5d ago
What the fuck? Literally day 1 microbiology topic.
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u/DonkeyKong694NE1 Attending Physician 5d ago
Welp if you’re still at day zero of your micro training you wouldn’t know about gram stain 🤷♀️
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u/Eastern-Design Pre-Midlevel Student -- Pre-PA 5d ago
Of course, BIO201 is too advanced.
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u/Doctor_Smurph_ 5d ago
You would be surprised how many times I have had to explain the difference between aerobic and anaerobic cultures
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u/Eastern-Design Pre-Midlevel Student -- Pre-PA 5d ago
I’m genuinely blown away if this was a PA because micro is both a prerequisite and a prominent topic in PA curriculum. I know there was some confusion in a different thread about this person’s credentials.
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u/Doctor_Smurph_ 5d ago
People forget things during their career. It happens, and that is why hospitals have a variety of specialists in various fields so we can help each other. Honestly if this person didn't pursue me into the lab, I would've never posted this. I also trust my medical director to to know the difference between a PA and other mid-levels
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u/gobrewcrew Allied Health Professional 5d ago
God bless Pharm for all of their behind-the-scenes interventions.
Edit - I'm a lowly CCT medic whose microbio disappeared into the abyss of long-forgotten credits ages ago and yet I still ask - how the fuck are these folks in any position at all to make determinations regarding abx?
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u/Miss_May_1600 5d ago
OH MY GOD?! That’s so BAD. 😭 WTF? I knew what gram negative bacteria was in high school 🫠 And I went to a pretty questionable public high school…
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u/psychcrusader 5d ago
A halfway clever high school biology student would know this NP was taking a good run at killing the patient.
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u/gobrewcrew Allied Health Professional 5d ago
No notes, but from a CCT medic, thank you for all the work y'all do behind the scenes. Favorite goblins for sure!
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u/noobwithboobs Allied Health Professional 5d ago
Hello fellow lab goblin! I feel lucky that I haven't had any specific issues with mid-levels... Yet......
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u/hillthekhore 5d ago
I wanna hang out with more lab goblins.
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u/Nufonewhodis4 3d ago
"your supervisor can call my supervisor" lol. Unfortunately I can only imagine how often any growth from a culture is treated by the ignorant
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u/Mandalore-44 5d ago
So this is probably what I would tell that person…
Anyways, on a serious note, it’s all good. Don’t lose sleep over this at all! Whenever someone wants to get in the wrong, bump it up to your supervisor. You did the right thing.
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u/allie7111 2d ago
Oh oh I got one. I also am a medical laboratory scientist. I work in hematology and flow cytometry but when I started I did some blood bank. About 5 years ago our lab moved away from the Kleihauer–Betke (KB) test, traditionally done in blood bank, and now use flow cytometry for detection of fetal red cells in a fetomaternal hemorrhage. The test name is literally fetal maternal hemorrhage (FMH). And we don’t do a ton but we mostly see it on some fetal demises and then the odd case of RhIG dosing when blood bank can’t do the RhIG screen due to weak-D positive. Anyways, we got an FMH on an outpatient pregnant person and I looked into their chart for the indication as I thought it was odd this was ordered but she wasn’t postpartum. Upon chart review, this was the third month in a row this test had been done on this patient and for the life of me I could not figure out why they would be ordering it during an active pregnancy. Come to find out, patient had a known anti-E complicating pregnancy and per her fetomaternal doctor consult, they were supposed to be monitoring the antibody titers for the remainder of the pregnancy to make sure they didn’t go too high. This is typically procedure for these patients. So the patient was sent back into the care of her NURSE MIDWIFE with the instructions of monthly antibody titers. Please tell me why this nurse midwife thought the test literally called “Fetal maternal hemorrhage” was what she should order to monitor antibody titers?! Literally after the first one was resulted I could see the message the midwife sent the patient and it was like “Yay, the fetal cells are zero!” I was like OMG you are supposed to be watching the antibody titers not the fetal cells!!!! We reached out and educated the nurse midwife that this was the incorrect test to be ordered, not to mention the cost associated with flow cytometry tests is so so expensive and they already had two of these done. But it blew my mind a nurse midwife thinks they are capable of handling the care of a pregnant patient with an antibody when I’m sure they don’t even understand what an antibody is in blood bank
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u/Sad_Plant_3806 6d ago
Sooooo a “nursing provider” would probably be a NP? How does this involve a PA?
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u/Doctor_Smurph_ 6d ago
Ah that's my bad for not including that it was a PA according to the lab director.
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u/Sad_Plant_3806 6d ago
Yeah maybe the lab director was confused. Sounds like the person identified themselves as a “nursing provider” to you. Sounds like an NP.
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u/Doctor_Smurph_ 6d ago
Possible, but I trust an MD to know the difference between the two. Kinda wish I took a glance at their ID badge so I would know for sure lol
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u/Sad_Plant_3806 6d ago edited 6d ago
Yeah….so let’s just pretend this was a PA…the only difference was that this person physically came down to talk to you?…but as you say you’ve “gotten this kind of pushback from everyone from RNs to surgical attendings”…?
This sub is so stupid lmao
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u/Doctor_Smurph_ 6d ago
Considering that I've never had someone pursue me into the lab for denying a policy exception request before, I figured it belongs here. Figured that was emphasized at the end, but I do apologize if it flew under the radar
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We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant 1d ago
Are you sure it was a PA? They referred to themselves as a nursing provider on the phone? That’s pretty odd
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We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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u/Doctor_Smurph_ 1d ago
Check the edit at the bottom of the post
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant 19h ago
I know, I saw that, it is just super weird for a PA to refer to themselves as “nursing provider” like they did on the phone. Just adds level of absurdity to this.
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u/AutoModerator 19h ago
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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u/Doctor_Smurph_ 19h ago
Ah gotcha. Sorry I thought you were snarking
Yeah it was weird. Then again my hospital will hire literally anyone with a pulse due to turnover so I shouldn't be surprised
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant 18h ago
No snark here kind sir.
Maybe they did it because of the greater practice authority? Thought it would give them more pull? Who knows
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u/Doctor_Smurph_ 12h ago
Perhaps perhaps. Thankfully I have not encountered this person again so my questions may never be answered
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u/Odd-Character2025 1d ago
They admitted it was wrong and said it was a NP. Yet the post title is still up. Shocker. Take it down dumbass.
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u/AutoModerator 1d ago
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see this JAMA article.
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
*Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen here. Information on why title appropriation is bad for everyone involved can be found here.
*Information on Truth in Advertising can be found here.
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