Further to my post regarding private blood test results.
Thanks to everyone who replied, I’m beginning to feel more in control. I emailed the results to the doctor, he won’t discuss anything with me as they are from a private company. However he did pick up on my high ferritin reading and has scheduled a blood test via the NHS. Getting some action at last!
He advised I should talk to my endo about the thyroid results, bit difficult as I’m in the care of a specialist nurse who I had to virtually brow beat to get my Levo increased.
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Roulette26
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Your doctor won’t accept your private blood test results?!
I think that the doctor should accept your private blood test results and here’s why.
The General Medical Council (GMC) produced a Code of Practice for doctors called Good Medical Practice. Paragraph 16b of that document places a duty on a doctor registered with the GMC to “provide effective treatments based on the best available evidence”
Having looked at the rest of the Code of Practice I can’t find a definition of what the GMC say is the best available evidence.
What is NOT best available evidence?
When the medical profession talk about evidence, they often start talking about “Evidence Based Medicine”. Some doctors assume that “evidence” is only research, and usually reduce that research to Randomised Control Trials, which in turn are generally based on a sample of a population. Some Doctors think that is all Evidence Based Medicine is. But that is not the case. EBM has to be applied to the individual patient in front of the doctor. There is a very good video on Youtube to explain more about EBM and its pros and cons in this video by Strong Medicine
In fact, relying solely on Randomised Control trials can be in conflict with the GMCs guidance that good doctors must treat each patient as an individual .
It is important to note the the GMC doesn’t actually say that the doctor must use EBM alone. The GMC clearly say Best Available Evidence, not solely EBM.
What IS Best Available Evidence?
To break down what this duty with regard to blood tests means, I'll discuss what “evidence”, “available” and “best” means.
In general, evidence is anything that can be used to prove something. Evidence of whatever type must be both relevant and “admissible” - in this context usable. Evidence is
relevant if it logically goes to proving or disproving some fact at issue.
It is usable if it relates to the facts in issue, or to circumstances that make those facts probable or (improbable), and has been properly obtained.
For the purpose of presenting blood test evidence to a doctor I’ll say that there are 3 types of evidence.
“Witness” statements. These can be
in the form of letters to the doctor describing signs and symptoms and the results if your treatment
or
simply telling the doctor your symptoms in the surgery.
Real Evidence. This means tangible items. In this case it means the patient in front of the doctor. This can be the signs of thyroid disease such as weight gain or samples of thin hair. Or how the patient improves stays the same or worsens after a change in therapy.
Documentary evidence. This is the main reason for this article. Blood test results are words and images on paper or an electronic file. They are documents. They are therefore documentary evidence. They prove the facts at issue so they are relevant and they relate to the facts at issue so they are “admissible” i.e. the doctor should accept them.
What does “available” mean?
If we look BAT, Available means
those (techniques) developed on a scale which allows implementation in the relevant industrial sector, under economically and technically viable conditions,
taking into consideration the costs and advantages,
whether or not the techniques are used or produced inside the Member State in question,
as long as they are reasonably accessible to the operator;
The medical evidence developed on a scale which allows implementation in the relevant medical sector,
under economically and technically viable conditions,
taking into consideration the costs and advantages,
whether or not the evidence is used or produced inside the Member State in question,
as long as they are reasonably accessible to the operator;
What does “best” mean?
means (the techniques) most effective in achieving a high general level of protection of the environment as a whole or the most valid and reliable – evidence.
In the general case I interpret this means having regard to the current state of medical knowledge.
In the specific case of blood tests, I think this means that the blood tests have been carried out by a laboratory that has been properly accredited by United Kingdom Accreditation Service to ISO 15189 Medical Laboratories – requirements for quality and competence for the tests it has carried out.
UKAS ISO 15189 accreditation covers the following disciplines:
What does the NHS say about accreditation schemes?
NHS England, NHS Improvement and the CQC are committed to, and
strongly endorse, participation in accreditation schemes for diagnostic
services. Participants in these schemes undergo a rigorous independent
review of their services, at regular intervals in time, and have systems in
place for ongoing and continuous quality management and service
improvement.”
NHS England, NHS Improvement, Care Quality Commission (CQC),
Communication to Chief Executives and Medical Directors of all NHS Trusts, October 2018
In addition, the GMC in “Consent: patients and doctors making decisions together” paragraph 5b places a duty on a doctor to use specialist knowledge and experience and clinical judgement, and the patient’s views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient.
By showing your doctor your private blood test results you are demonstrating your knowledge and understanding of your condition.
Conclusion: According to the GMC, a doctor has a duty to consider your private blood test as the best available evidence of your thyroid hormone levels.
Funnily enough I'm doing the same thing to help patients with their lab results i.e. compiling which of the featured labs on the Thyroid UK website have accreditation.
Medichecks don't say they use UKAS accredited labs. They say they use NHS standard labs. However, most NHS Labs do have UKAS accreditation.
Genova Diagnostics are American and are accredited to the US version of ISO 15189 which is slightly different. Blood samples are sent to the US labs for analysis.
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Further advise on Endo instructing to stop T3
Results need further attention, speak to your GP
What a difference a day makes (and a change of GP surgeries)
Absolutely awful, is there anything I can do further.
T4 to T3 conversion – blood tests versus urine tests
