Update on Quest

Recall my scare last week, with a false (very high) positive PSA test result from Quest.

Just as an update, i finally got a call today, from a Dr. at Quest Diagnostics Corporate Headquarters on the West Coast. I did not get his name, i was driving when the call came, and couldn't write it down. He said he would be sending me an email with his contact info, but i haven't received it yet.

In any case, they did a full investigation, and looked at the tests before mine and after mine on the same machine, and they were fine, so they have ruled out miscalabration of the machine. Through whatever process they have, they also ruled out mix up in tubes resulting in my getting a result from someone elses blood, and finally ruled out the possibility that my results were misreported/switched with someone elses.

I believe he said that the retested the blood with the same result. So they conclude that there was contamination in the blood sample, possibly stemming from a fiber or soemthing being in the test tube before the blood came into it.

I told him that members of this unique group have also reported issues with PSA including one whose Dr indicated that he had 8 patients come back with false positives recently, and that was very concerning to me, for the sake of others. He responded by saying that he will bring it up at the next meeting of the "whatever" committee, and make it a point to have all of their PSA processes and machines checked and rechecked for any possible issue.

Lastly, i wondered aloud to him, why someone wouldn't, on a post prostatectamy test, check the previous test result of that patient (me) and see if it made sense (which this clearly didnt due to the undetectable 3 months ago). Surprising answer.....He told me that Quest does not have things set up to give them the capability to look back in a linear way, at blood tests, and even treatment history of a patient. He said it is something he has been loudly asking for for quite some time. And he said "in all honesty, some of our competitors do have this capability, but we are just not there yet"

Lastly, i told him that my confidence in Quest has been shaken and i am not sure that i would want my PSA tests done their in the future. I explained to him, that this is a number that I, and many others in my position who i know, hang on, and even whose lives to some extent revolve around. And they have a moral obligation to be as perfect as possible. He understood that, and asked that if i do test again at Quest, i contact him, and let him know, and he will personally oversee the test results, and examine them before they are released.

i decided, there was no point in asking for a written response, which i originally wanted. It wouldn't change anything, and they would probably be afraid to put any of this in writing, compliance would object. So i decided not to be an a-hole about it. I feel like I've done what i can, including making others aware. I hope that they fix what they have to fix, or that it was a one off (probably not). But I'll go to my Dr going forward, at least for my PSA test.

I hope some good will come out of this for someone.

Prat:

Thanks for the follow-up report.

As a direct result of what I read here, I would not use QUEST for my PSA tests (and probably not for any tests).

That's too bad because I THINK one can peruse results online, and they are also the default lab for my MediCare Advantage Plan.

(As an aside, does anyone know if that's true regarding online results).

That would be very convenient, but the test is too crucial to have the seeds of doubt.

Mel

Pratoman,

I'm sorry that this regrettable experience happened to you. I empathize with your negative feelings.

Medical Diagnostic Labs are required by federal regulations to run control samples along with patient samples. These control samples correlate with the range of values that the instrument can detect, from low to high. If the control samples are not within ranges, all patient samples must be rerun.

The lab must also calibrate its testing equipment regularly, to insure accuracy. Some labs rerun abnormally high patient specimens. Megalabs like Quest and LabCorp are a big business, and look to cut expenses in any way possible because they are in competition just like Pepsi and Coke and have narrow price margins. They are production-oriented and anything that slows it down or adds to their cost, like comparing your results to previous results, rerunning abnormal highs, etc. ain't gonna happen. The difference in quality between LabCorp and Quest? None. They already do more than half of the lab testing in the US. Google each business along with "complaints" and you see a lot of issues for both.

Ken said...
I read this right after prat orignally posted, couldn't come up with a good way to frame my post.

Somehow, the good Dr's response isn't sitting well with me. Retested blood with same result? Would he mind sending the printouts?

Partly because I fail to see how a contaminated sample tube would raise PSA. Specifically PSA? Are you kidding me?

Contamination, ok I can believe that. But I would normally think that contamination would simply render the results useless, or way off the chart astronomically. Bump that Prato had? I am skeptical.

More like, if we blame this on contamination everyone is happy and no one gets fired, or loses their promotion or next job opportunity.

CAVEAT: I alternate and struggle between Cynical Skepticism and Skeptical Cynicism. From week to week, not sure which week I am supposed to be on at the moment.

Ken--An excellent observation

There probably is no answer, Allen, because TimG's comments are spot on. These huge labs have shareholders to answer to and so anything that increases expenses, is going to have to be very comeliness to introduce, from either a regulatory, or compliance standpoint.
Surprisingly (or not) I never did get the email as promised, with the Drs contact information. Either, he forgot when he got to the office (he called me from home at 6:30 AM HIS TIME) or he decided anything in an email cannot be something that would end well.

Doesn't matter, I'm not using them anymore, at least not for PSA. Im planning on using my Uro/Surgeons hospital lab from now on. Partly because one thing I've learned from this is that PSA results are something my Drs office should see before I do. (Considering what a "calm" demeanor I have

Halbert:

I might have agreed with you 5 years ago. But, for many of us on HW, we are pretty knowledgeable. I prefer getting my results ASAP. In my locale, I go to the Medical Records office the next day, pay them $1., and I get a copy of my test results right away.

Mel

Your stress levels about all this is understandable...it's all still quite new to you. But I'll give you newby favorable risk guys--like halbert and Pratoman--some insight into what your future might be like...

I started out in the first year getting the typical PSA test at Quest on a 3-month cycle, then after a year or so it flipped to annual. I can't remember, there might have been a 6-month one in between somewhere. Quest called my Urologist, and he'd email me the results.

All this time at my annual physicals, my internist would ask about PSA testing as we were ordering up other blood work. I would reply that I had been tested and the result was undetectable. Obviously no need to retest.

After about the 3rd year or so I couldn't remember what month I was supposed to get my annual PSA test in...was it March, or April of last year, or maybe May? It simply wasn't THAT important to keep on the top of my mind. By year 4 or 5 I simply told my Uro I'd have my blood drawn by my internist at the same time other work was done to save time, and save the hassle of having to remember one more worthless scrap of information.

Now, I have all the blood work with my physical (I go to Quest the week before I see the doc), and I simply send the result to my Uro by email in the next day or two.

It's all pretty low stress. Of course, this low-stress perspective is all made possible by my very common favorable risk case...similar to yours, although mine had a little worse pathology. Having likely been over treated for PC, I'm far more interested in my heart disease indicators at my physical.

Post Edited (NKinney) : 10/16/2015 12:39:38 PM (GMT-6)

NK:

Must be nice to have no stress.

I envy you

Mel

So i did get the email from the Dr at Quest, as it turns out he's not an MD, but a PH.d. Title is "Director, Test Development and Design, Senior Scientific Director Oncology/Coagulation"

I (probably made the mistake of) asked him to confirm if i was correct in hearing him say in our phone conversation, that they retested my blood with the same result and if that was what led them to conclude that the sample was contaminated. And if i was correct and that was the case, should i be thinking about retaking the undetectable result i got at My Drs hospital lab, just to be sure.

I am thinking, the 3.38 result was so out of whack that i have to assume the undetectable result was the correct one. But i just cant seem to let it go without asking. I'm not nervous about it (any longer) so i should have just left well enough alone. But i cant.

Anyway, its good to know i have a contact at Quest, if i ever need one (not that i plan on using them again if i have a choice.)

Ok, I'm suggesting a chill out moment. They don't know what happened. And, it may be unknowable what happened. Fact is, you said, "we have a problem", they went back and retested, and said "OMG, we have a problem. What happened?"

This will be filed in the "something weird happened on day X with tech Y and machine Z" file. They'll watch tech Y and machine Z for a while to see if it happens again. And that will be the end of it.

The recheck showed the zero, and that means there wasn't contamination either at the blood draw or when the sample was prepped (the aliquot). Rest assured, if they DID know what happened, they'd tell you...they have to. If you report it to the certifying authority, they'll do a minor investigation, and nothing will come of it. Why? Because the QC results and the retest all say "we're good". In the end, everybody responded as they were supposed to, and the questioned result is thrown out. Human error? Probably. But proving it is almost impossible short of obvious negligence or incompetence.

Thanks Pratoman. I write all this as a confirmed "Lab Rat". Sometimes weird results just happen. My problem with Quest (and any other outfit that reports results online without commentary) is that they purposefully do not look at the patient and what "should" come up on the results. They publish what is in essence raw data, and leave it to the patient to evaluate it. Which, for the most part (people like us mostly excepted) people are not capable of doing.

^^ Well said ^^

Prat:

I have to disagree with you (about eliminating the patient portal). Mistakes are very rare, but they happen. One of the HUGE plusses of dealing with QUEST would be the patient portal. As I indicated, I WAS seriously thinking of switching to QUEST

My doctor has a patient portal. They do post the results, but after a long delay. Umich has a patient portal and they post the results when they get it. I go to the Medical Records Office, pay the dollar, and get the results the next day.

Eliminating the portal would be like throwing out the baby with the bath water.

Now, if QUEST had a systemic problem with a bunch of different tests, then you are talking a different ball game (probably liability, too).

Mel