Referring women with sickle cell trait to Laura Long
Lily Dalke
Please see Laura's email below about referring women with sickle cell trait - the short answer is we shouldn't refer routinely right now, but she would like help figuring out how to make sure women are correctly understanding this diagnosis.
---------- Forwarded message ----------
From: Laura Long <llon...@gmail.com>
Date: Fri, Aug 16, 2013 at 10:04 AM
Subject: Re: Question
To: Lily Dalke <lily....@gmail.com>
Hi Lily,
Hah I just saw the time of your e-mail! Such a thing to think about at 3:30 in the morning!
I did tell you to send them all to me, but I'm needing to work some things through in the next month or so. Here's the problem: Dr. Brabham told me recently that she had a pt who had a baby with sickle cell disease after the pt told her that FOB did not have trait. This was not a case of non-paternity, but rather a woman who believed FOB was negative on the basis that none of their other kids were sick. Yikes. So obviously we need to make certain that our patients understand the genetics.
I was doing this educating one-on-one but other things are about to change that might make it impossible for me to see all these patients. Sometime either next week or the week after, Non-Invasive Prenatal Screening will be available for our patients. I've been slowly piloting this to see how it goes before I roll it out for all. When this happens, ALL AMA's and abnormal QUADs will need to go through me so that women can choose what kind of testing they want or which test is most appropriate. Dr. Atallah and I have been working out a system to help make these referrals happen automatically. I'm predicting that my template is going to be much tighter than it has been.
So in a long answer to a short question, I'll take everyone at this point, but I'm not yet prepared to make that policy. I obviously need to come up with a plan for broad based education and more targeted one-on-one. I have a few ideas about this, but I'm completely open to other's thoughts.
On Fri, Aug 16, 2013 at 3:26 AM, Lily Dalke <lily....@gmail.com> wrote:
Hi Laura -
I asked you about this in passing the other day, and I thought you told me "yes" - but then one of the other midwives questioned me about my referral of someone to you for this reason, so I thought I would double check.
Should we be referring women with sickle cell *trait* to you? If yes, is this all women with the trait or only those whose partners also have sickle cell trait or are unavailable for testing?
Thanks - and I'll share your response with the group so we can be sure to all be on the same page.
Lily