A Night in the Emergency Department:

(what I work with every day; Anonymous ED PA)

Choose your preference from the following scenarios:

1.  You are on duty, working your shift in the ED, attending to a patient with abdominal pain. As part of your work-up, a rectal exam is indicated. You don your gloves and you ask the tech if they know where the bottle of developer is. You perform the rectal exam as she goes to see if she can find the bottle. Meanwhile, you have completed the rectal exam and have applied the stool sample to the cardboard FOBT slide. You stand there for four precious minutes while the tech comes back to you with the developer.

Before you take it from her, you wonder if the outside of the developer bottle is contaminated with feces. You also wonder if the inside of the bottle has fresh developer. Hasn’t that same bottle of developer been lying around for months? Now you take off the gloves you just performed the rectal exam with and put on new gloves just to unscrew the cap and squeeze a few drops of the developer onto the test area. Now throw the whole thing out, after putting the developer bottle on the nearest counter.

2.  Or do you reach into you pocket and get out your own personal bottle of developer that you know has a clean outside? Either way, I’ll bet you that the developer is NOT lot # matched to the guaiac slides. Does your lab director know what you have been doing? You record your results, but are cheating the system out of doing the test the proper way and cheating your institution out of billing for the test. In this age of crisis with health care reimbursement every dollar matters.

3.  Now imagine the following. You do the same rectal exam on the same patient, but instead of wasting time and getting frustrated and possibly contaminated, changing gloves twice, you merely apply the stool sample, snap the cover closed, push down gently on the ColonTest FOBT, and get your results instantly.

Which would you rather do?