Communication problems
The following are all genuine cuttings taken from the cards which accompany medical specimens sent to a laboratory for bacterial testing. On these cards there are supposed to be the following:

• The patient’s details (name, date of birth, etc);
• A brief diagnosis, or description of the patient’s symptoms;
• What test is required, usually referred to as Culture and Sensitivity (we culture the bacteria, then determine to which antibiotics it is sensitive);
• A brief description of the nature of the specimen.

While this should be fairly simple, it is sometimes amazing, sometimes quite frightening what can actually end up being written on these cards. As I say, these are all genuine and was passed onto me maybe fifteen years ago by someone who worked in a path.lab.

Parts written in italics are added by myself. As a help, HVS is an abbreviation for High Vaginal Swab, UTI is Urinary Tract Infection, MSU is Mid Stream Urine, ICU is Intensive Care Unit a question mark before something means “query”, eg, “?UTI” means “does this patient have a urine infection?”

As usual, in reply..
( sandettie light vessel automatic New Twitter - @bollocksreally, Wed 17 Mar 2010, 12:30, 10 replies)

Communication
DIAGNOSIS: Sore throat
NATURE OF SPECIMEN: High vaginal swab
Three such examples have been received to date – and two of them claimed to be from male patients!

DIAGNOSIS: Knee infection
NATURE OF SPECIMEN: Ear swab

DIAGNOSIS: Discharge from vagina
NATURE OF SPECIMEN: Pussy swab
I think they meant the swab was of pus!

PATIENT:
DIAGNOSIS: Sticky right eye
NATURE OF SPECIMEN: HVS

PATIENT:
DIAGNOSIS: Menstrual bleeding and vaginal discharge

DIAGNOSIS: Fractured forearm, sailor
NATURE OF SPECIMEN: Little toe

PATIENT:
DIAGNOSIS: Runny green discharge from nose

DIAGNOSIS: Infected wood

DIAGNOSIS: Infected wand

DIAGNOSIS: Amputation of right fourth foot

DIAGNOSIS: Has diarrhoea, works in a microbiology laboratory, and is a 2 month old baby.

DIAGNOSIS: ?Diarrhoea
The temptation was to send out a report saying simply “Yes, it is!”

After foreign travel, doctors sometimes write, for example “Ex-Majorca”. I once received:
“Ex-Crete Diarrhoea”

DIAGNOSIS: Infertility
NATURE OF SPECIMEN: Ear swab

DIAGNOSIS: Ear infection
NATURE OF SPECIMEN: MSU

NATURE OF SPECIMEN: Swan from right leg
This one came up on the computer, I think the office were to blame –

DIAGNOSIS: Newphonia

DIAGNOSIS: Diarrhoea, patient recently married

DIAGNOSIS: Urine infection
NATURE OF SPECIMEN: Groin swab
Why? Does the patient dribble?

DIAGNOSIS: Pussy tonsils

DIAGNOSIS: Clumpy consistency to semen, “metallic taste”

DIAGNOSIS: Wheezy sloppy stools

DIAGNOSIS: Pregnant diarrhoea

NATURE OF SPECIMEN: Virginal swab

DIAGNOSIS: Recurrent leg ulcer has hearing aid

DIAGNOSIS: Intermenstrual bleating
“Baaa!!”

DIAGNOSIS: Fishy dish PV

DIAGNOSIS: ?
Very detailed diagnosis, that one – but honest!

DIAGNOSIS: Oral thrush
NATURE OF SPECIMEN: Buttock swab

NATURE OF SPECIMEN: Bleeding irregular

DIAGNOSIS: Leg ulcer
NATURE OF SPECIMEN: Wound odour

DIAGNOSIS: Patient vomiting blood
NATURE OF SPECIMEN: Penile swab

DIAGNOSIS: Thrust

DIAGNOSIS: Wand exudate

DIAGNOSIS: Penile discharge
NATURE OF SPECIMEN: Penile swab and right ankle swab

DIAGNOSIS: Right wipe weeping

DIAGNOSIS: MRSA
NATURE OF SPECIMEN: Thought
On opening the bag containing this specimen, I found the “thought” swab was actually labelled “Trought” – it is interesting to note that this was from the ICU!!

DIAGNOSIS: Threat worms

DIAGNOSIS: Faeces?
Hint to medical staff – where did it come from?

DIAGNOSIS: 3D Diarrhoea

DIAGNOSIS: Rectal bleeding
NATURE OF SPECIMEN: Nose swab

DIAGNOSIS: Acute diarrhoea, printer not working

DIAGNOSIS: Virginal/anal discharge

DIAGNOSIS: ?Infection, button

DIAGNOSIS: ?Chest infection ?UTI
NATURE OF SPECIMEN: Stool

DIAGNOSIS: Sore throat
NATURE OF SPECIMEN: Urine

NATURE OF SPECIMEN: Penal swab

DIAGNOSIS: Leg ulcer required

DIAGNOSIS: ?Thrush around mouth
NATURE OF SPECIMEN: Groin/testicle swab

DIAGNOSIS: Collapse, fits, UTI, computer not working

DIAGNOSIS: Thursh

DIAGNOSIS: Left foot ankle ?ulcer
SPECIMEN: Penile swab

DIAGNOSIS: Offensive neonate
Aren’t they all?

DIAGNOSIS: Tonsil commando

DIAGNOSIS: Swab Right breast?
Don’t they know?

DIAGNOSIS: Tonsillitis + Pharyngitis
SPECIMEN: Stool sample

DIAGNOSIS: Head injury
SPECIMEN: Stool sample

DIAGNOSIS: ?Arthritis ?Septic ?Grout

LOCATION OF SPECIMEN: Right foot Left leg

DIAGNOSIS: Neurotic tissue

DIAGNOSIS: Pre-post natal
A sort of “before and after” swab then?

DIAGNOSIS: ?Constipation
SPECIMEN: Swab of left ankle

DIAGNOSIS: Infected leg ulcers
SPECIMEN: Stool sample

DIAGNOSIS: Irretible (sic) hip
SPECIMEN: Throat swab

DIAGNOSIS: ?Heart failure
My god, they have to send a swab to the lab to find this out??

SPECIMEN: Swab of fourth finger, Right foot

DIAGNOSIS: Pyrexial screaming

DIAGNOSIS: Ear coli

SWAB LOCATION: Tracheostomy sight

DIAGNOSIS: Confusion screen

SPECIMEN: Swab of labia – very pussy

PATIENT:
SPECIMEN: Swab of penis

DIAGNOSIS: Fractured swollen right ankle
SPECIMEN: Nose swab

DIAGNOSIS: 27 days post Caesarian. Hellp! Twins!

SPECIMEN: (from the Opthamology ward of the Eye Hospital) Swab of base of Right Heel (perhaps they were holding the patient upside down?)

DIAGNOSIS: ?UTI
SPECIMEN: Urine
SITE OF SPECIMEN: Tracheostomy

DIAGNOSIS: Patient not passing urine
SPECIMEN: Urine

EXAMINATION REQUIRED: MRSA Screen, Nasal
SITE OF SPECIMEN: Chin

DIAGNOSIS: Diarrhoea – sent on computer

DIAGNOSIS: Pathological dipstick

DIAGNOSIS: Chest pain from Scunthorpe

DIAGNOSIS: Generally unwell, loose stools for 4 months
SPECIMEN: Eye swab

DIAGNOSIS: Anal pain
SPECIMEN: Urine

DIAGNOSIS: Diarrhoea transfer from Ward 5

DIAGNOSIS: Recent loose stole
Do we LOOK like we deal in furs?

DIAGNOSIS: ?Circumcision
They don’t know????

DIAGNOSIS: Sore Throat
SPECIMEN: Stool

DIAGNOSIS: Dislocated hip
SPECIMEN: Sputum

DIAGNOSIS: Geographical tongue


In the space on the card for the diagnosis, we once came across the following:
Roundworm found in toilet, ?origin, patient? Worm put in container, but escaped.


One doctor started on the wrong foot by asking not for culture and sensitivity, but culture and sensibility.


Diarrhoea
Worthy of a mention of it’s own, as it seems to be something a lot of people have trouble with – spelling it, I mean! Examples I have seen include:

Dhiorria
Diahorrea
Diahorria
Diahorhea
Diarrheea
Diahorroea
Diarrohea
Diarrhea
Diaoreah
Diahorreahoe
Dioreha

And the best yet – Dire Rear

We also had “Diarr ” – they obviously just gave up halfway through!

I received one card on which was written two incorrect spellings, crossed out, another attempt which was tip-exed out, and finally “Loose stools”. On closer examination, I could make out under the Tip-ex the words “The shits”!!


Telephone Conversations
You’d think that having received the sort of specimens listed above, that going into hospital isn’t a very wise thing to do. However, those are not the most worrying things I’ve encountered. I regularly have to answer the telephone to doctors and nurses wanting the results to samples they have sent in. Below are just a few examples of the more interesting examples.


“I’m ringing for the results of a blood culture I sent down yesterday. Do you need the details?”
no, I’m psychic!


“Do you have a urine result from February, please?
“About six thousand. Do you want one in particular?”
“Oh, yes, the patient’s details would be helpful, wouldn’t they?”


I received a “tip” specimen (the end of a tube, inserted into a vein) sent from a ward. The specimen was labelled “John Smith”, while the accompanying card was labelled “Fred Bloggs” (names have been changed for confidentiality reasons). I rang the ward:
“Are you sure?” they asked.
“Yes,” I replied.
“Oh… wait a minute…”

“Hello, this is Staff Nurse, can I help you?”
I explained the problem.
“Are you sure?”
“Yes!”
“Oh… it’s just that John Smith still has his in place, and Fred Bloggs was discharged 2 weeks ago.”
“So who’s is this?”
“I don’t know. Just throw it in the bin!”


“One of our patients has been started on Kefotaxime, but I don’t know why. Can you check on your computer to see if any results would suggest why?”


“Can you check to see if we’ve sent any specimens form this patient, I’m afraid we don’t keep very good records”
That was from Intensive Care!


After looking for a specimen on a computer, I reported:
“I’m sorry, we don’t appear to have received that specimen.”
“Oh. So when do we get the results?”


Me: “Do you have the patient’s date of birth?”
Doc: “Ermm… 1975.”


Me: “…and there was no bacterial growth.”
Doc: “So could you suggest a suitable antibiotic?”


“Have I reached the right place to get an MSU result?”
“Yes, what’s the patient’s name?”
“Oh, hold on, I’ll go and get the files…”
she took 1 ½ minutes!


Some swabs arrived with no examination requested. They were labelled Ward 11. I rang Ward 11. I asked if they could tell me what test was required.
“Oh, you’ll have to speak to Ward 10 about that. He’s on our ward, but we’re not treating him”


“… and there’s no bacterial growth.”
“So nothing grew then?”
“No, there’s no growth.”
“So no streptococcus or anything?”
"No, there was no bacterial growth.”
“…So that’s it then?”
“Yes!”
“…okay… we sent a blood culture from her as well…”
“I’ll just check on the computer…oh, we don’t appear to have received a blood culture form her”
“Oh no, it wasn’t from her, it was form a patient called…”


Me: “We’ve received a specimen from a patient of yours. It appears to be a urine catheter tip, but it’s not labelled. Can you just clarify this please?”
Staff Nurse: “Yes, no problem, hold on please…”

Staff Nurse: “Yes, it is a urine catheter tip.”
Me: “Okay. Unfortunately we don’t process those, we find we get a much more accurate result if you send a sample of urine.”
Staff Nurse: “Oh, why, what did we send?”


Me: “…and there’s a heavy growth of candida.”
Nurse: “…what was that?? Cannabis?!?”
( sandettie light vessel automatic New Twitter - @bollocksreally, Wed 17 Mar 2010, 12:31, closed)

I am amazed
but not that much! Some of those are pure win!
( Blind Meach Cautiously optimistic, Wed 17 Mar 2010, 13:49, closed)

Haha, blimey :)
I train medical staff on those sorts of computer systems. A while back I was training a room full of junior doctors. One of them was looking. Through a list of available specimen types and exclaimed loudly

"What the hell is 'sputum'?!"

A whole room of people (me included) looked at him incredulously and chorused "saliva!" :)
(Professor Kenny Martin Hmm? What?, Wed 17 Mar 2010, 13:54, closed)

Which is not what sputum is....!

( sm.pl.crt.rs I don't fucking know, do I?, Wed 17 Mar 2010, 16:36, closed)

Oh noes!
The chorusing of "saliva" must have only happened in my head then! The incredulous looks were definitely real though - and I'm pretty sure a qualified doctor should know what it is...

...what is it then?
(Professor Kenny Martin Hmm? What?, Thu 18 Mar 2010, 0:31, closed)

you're close
but if you're being picky about things, saliva is fairly thin and runny and produced in salivary glands in your mouth, whereas sputum is the thick gloopy stuff you tend to cough up from your lungs when you're sick.
(xanthine, Thu 18 Mar 2010, 6:35, closed)

made me snort and snot bubble..
Thanks for the cheering up.. Needed that..

We used to ask new teachers to spell "diarrhoea" as a test to see if they were any good... Let them off if they laughed though, obviously..
(Beer Elf Thought this was like a campfire, anyhow, on, Wed 17 Mar 2010, 17:13, closed)

Diarrhea
is correct if you're a Yank.
( idonthaveafunnynickname Drink-Aware? Sure. I'm aware I want another drink., Thu 18 Mar 2010, 1:00, closed)

win
thanks for the laughs.
(Archeleus hates cabbage, Thu 18 Mar 2010, 1:15, closed)

My Personal Favourite

DIAGNOSIS: Diarrhoea, patient recently married

This is just brilliant!
(Sadarse works like Mist condensing mud flaps, Thu 18 Mar 2010, 7:23, closed)