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Can you order labs for a patient you haven't seen?

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  • legobikes legobikes 
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    Or is this a clear violation of some sort? Asking because a family friend asked me about their kid’s allergies and eczema, and I had recommended considering an IgE allergen panel. They’re visiting the US and were wondering if I could order it based on the history. I’m comfortable saying no, but I’m wondering about the actual legality and logistics.

    #226880 Reply
    CordMcNally CordMcNally 
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    This sounds like a great thing for them to talk with their pediatrician about when they get back home.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #226883 Reply
    Rogue Dad, M.D. Rogue Dad, M.D. 
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    Yes it’s “legal” but certainly needs to be appropriate — labs don’t know if you have an existing doctor-patient relationship and most won’t ask you for justification.

    If you don’t have a doctor patient relationship it’s going to potentially open up issues for you depending on what you order.  Allergy testing may be “low risk” but not sure why you need to do it for them on an international trip when they won’t use the results until they get back and you won’t be telling them what to do with it.  It’s also going to cost more in the US than almost any other country in the world.

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    #226886 Reply
    Avatar Peds 
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    Don’t get me started on shotgun IgE testing…..

    #226933 Reply
    CordMcNally CordMcNally 
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    Don’t get me started on shotgun IgE testing…..

    Click to expand…

    What do you think about shotgunning IgE testing…?

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #226934 Reply
    Avatar HikingDO 
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    Can you? Yes. Should you? No.

    #226937 Reply
    Liked by Tim
    legobikes legobikes 
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    Don’t get me started on shotgun IgE testing…..

    Click to expand…

    Yeah I know. In this case mom was told to lay off a bunch of stuff and not feed the kid apples or bananas. Sounded silly to me. I suggested a food panel as a rule out, since that’s the only thing it’s really good for anyway.

    #226954 Reply
    Avatar Peds 
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    Its not though…. That’s the problem

    #226960 Reply
    Rogue Dad, M.D. Rogue Dad, M.D. 
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    Yeah I know. In this case mom was told to lay off a bunch of stuff and not feed the kid apples or bananas. Sounded silly to me. I suggested a food panel as a rule out, since that’s the only thing it’s really good for anyway.

    Click to expand…

    Is there any reason they can’t go back home and have someone order this?

    This is like the opposite of medical tourism — they are going to the highest priced country in the world and will have a single random test done with no associated care given and which they may not need, as opposed to going to a lower priced country and getting a better cost with more care bundled that they do need.

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    #226964 Reply
    Liked by chrisCD, Peds, Lordosis
    childay childay 
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    I mean yeah you could but…  You would be responsible for the results though, required followup referrals, malpractice concerns if they do poorly etc.  Depends how close a family friend they are and what tests you’re ordering..

    #226983 Reply
    Liked by q-school
    legobikes legobikes 
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    Its not though…. That’s the problem

    Click to expand…

    Tell me more.

     

     

    RogueDad: she said something about how it’s not available there. I doubt it.

     

    Anyway, I just got in touch with another provider who is in their area, who will take a look at the baby and order the test.

    #226989 Reply
    ENT Doc ENT Doc 
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    Yeah I know. In this case mom was told to lay off a bunch of stuff and not feed the kid apples or bananas. Sounded silly to me. I suggested a food panel as a rule out, since that’s the only thing it’s really good for anyway. 

    Click to expand…

    Is there any reason they can’t go back home and have someone order this?

    This is like the opposite of medical tourism — they are going to the highest priced country in the world and will have a single random test done with no associated care given and which they may not need, as opposed to going to a lower priced country and getting a better cost with more care bundled that they do need.

    Click to expand…

    The wait in country “not USA” was 6 months for routine lab testing.

    #227094 Reply
    PhysicianOnFIRE PhysicianOnFIRE 
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    To answer the question, I do it all the time. HCG on a woman of child-bearing age. Electrolytes on a patient taking a diuretic about to undergo major surgery. Platelets before placing an epidural.

    But I’ve never ordered an IgE allergy panel.

    40-something anesthesiologist and personal finance blogger @ https://physicianonfire.com [Part of the WCI Network] Find me on Twitter: @physicianonfire

    FIRE. Financial Independence. Retire Early.

    #227103 Reply
    Avatar highdoseamox 
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    Not on someone who is not under my care or one of my partners in our medical group. Follow up seems like a problem.

    Tons of parents want IgE testing. It’s best used when pretrest probability is very high due to high false positive rate.

    #227105 Reply
    Liked by Tim, snowcanyon
    Avatar trebizond 
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    I don’t think there’s an ethical problem per se with IgE testing.

    I shy away from panels because they are overly broad. The one exception is environmental/aeroallergens, because identifying culprits on history is hard to impossible and there are many different potential sensitizations, although I have a preference for skin testing in that case anyway (yes, there is no difference between the two).

    IgE testing should be directed by detailed history taking. Only test for very specific foods for which there is a history of potential allergic reaction. This means you have to ask a lot of question about egg and dairy and soy and fish and shellfish and etc. And if it does not sound like type 1 hypersensitivity, don’t test for the GI intolerances, because the IgE level is impossible to interpret there.

    I would support 3 exceptions:

    1. Peanut testing for those with moderate-severe eczema or egg allergy or both, because the evidence supports doing this before they have ever tried peanut.

    2. Tree nuts when there is a peanut allergy and vice versa. Also sunflower seed when there is sesame allergy and vice versa.

    3. The family is deathly afraid of giving the kid specific foods, e.g. because of a family history. Then I will test more broadly – oftentimes with skin instead – to try to reassure the mother that little Johnny won’t die from trying a bit of shrimp – which he’s never tried.

    There is real harm done with panels, namely reduced quality of life by family slashing out all kinds of reasonable, wholesome, and pleasurable foods from the diet – the worst avoidances being egg, dairy, and wheat. Or, alternatively, not letting their kid visit a friend’s house because a cat or dog IgE was positive. In the worst case scenarios I’ve seen malnutrition requiring supplements because so many high calorie high protein foods were being avoided needlessly.

    #227119 Reply

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