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Should Patients Have Access To Lab Test Results Before Their Physician Reviews Them?

Six weeks ago I had a skin lesion removed by a plastic surgeon. About 7 days after the biopsy, I received a letter from the pathology lab where the sample had been analyzed under a microscope. I eagerly opened the letter, assuming that it contained test results, but was disappointed to find a bill instead. As a physician, it felt strange to be in a position of having to wait for a colleague to give me results that I was trained to understand for myself. However, I knew that in this case I was wearing my “patient hat” and that I’d need to trust that I’d receive a call if there was an abnormality. I haven’t received a call yet, and I assume that no news is good news. But what if no news is an oversight? Maybe there was a communication breakdown between the path lab and the surgeon (or his office staff) and someone forgot to tell me about a melanoma? Unlikely but possible, right?

Patients experience similar anxiety in regards to lab tests on a constant basis. In a perfect world, they’d receive results at the same time as their doctors, along with a full explanation of what the tests mean. But most of the time there’s a long lag – an awkward period where patients have to wait for a call or make a nuisance of themselves to office staff. Shouldn’t there be a better way?

The New York Times delves into the issue of “the anxiety of waiting for test results,” with some helpful tips for patients in limbo:

As patients wait for test results, anxiety rises as time slips into slow motion. But experts say patients can regain a sense of control.

  • Start before the test itself.
  • Because fear can cloud memory during talks with doctors, take notes. If you can, bring a friend to catch details you may miss.

Some pretest questions:

  • What precisely can this test reveal? What are its limitations?
  • How long should results take, and why? Will the doctor call with results, or should I contact the office?
  • If it’s my responsibility to call, what is the best time, and whom should I ask for?
  • What is the doctor’s advice about getting results online?

Do I think that patients should have access to their results without their physician’s review? While my initial instinct is to say “yes,” I wonder if more anxiety may be caused by results provided without an interpreter. There are so many test results that may appear frightening at first (such as a mammogram with a “finding” – the term, “finding,” may mean that the entire breast was not visualized in the image, or that there was a shadow caused by a fatty layer, or -less commonly – it can also indicate that a suspicious lesion was observed). I’m not arguing that patients can’t understand test results on their own, but medicine has its own brand of jargon and nuances that require experience to interpret.

Consider the slight deviations from the mean on a series of blood tests. They can be perfectly normal within the patient’s personal context, but may simply be listed by the lab as high or low. This can cause unnecessary anxiety for the patient. And what about PAP smear results that are listed as “ASCUS” – atypical squamous cells of undetermined significance? These can occur if the patient merely had recent sexual intercourse, and are not necessarily indicative of cancer at all.

And what about the “ambulance chasing lawyers” out there? Will there be additional frivolous law suits created by lab test results reported direct-to-consumer as abnormal in some way (when they really aren’t, given the full clinical picture) and patients assuming that their physician was negligent by not reporting the abnormality to them sooner? It could happen.

In the end I think that physicians all need to make a concerted effort to forward (with an explanation when necessary) lab test results to patients as quickly as possible. But since doctors are the ones ordering the tests in the first place, they do have a right to see them (before the patient when appropriate) – and an obligation to pass on the information in a timely and fully explained manner. That’s the value of having a physician order a test – their expertise in interpreting the results are part of the package (and cost). When patients order their own tests (and in some cases they can) then they should be first to receive the results.

As for me, I’m going to have to resort to “office staff nuisance” to get my results confirmed… just like any other regular patient. Oh well. ;-)


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6 Responses to “Should Patients Have Access To Lab Test Results Before Their Physician Reviews Them?”

  1. Lisa says:

    The doctor that I like (and trust) the most has me do the blood work a week before the appointment. At the appointment he hands me a copy of the report and explains to me what it means. I don’t mind that my doctors see the results before I do. I only mind when the say “Your blood work is fine” and not “Your A1c is 6.4 and your total cholesterol is 125″ You blood work came back fine isn’t really telling me anything. I really don’t like it when I ask to receive a copy and they tell me they will send me a copy, but never do.

  2. Excellent point, Lisa. “Fine” isn’t a very nuanced result summary is it? How would you like to take an exam and be told by your professor that your results were “fine?” Ha ha. Doctors need to do a better job of communicating test results to their patients – even if the results are all “within normal limits.” ;-)

  3. Barbara Bronson Gray, RN, MN says:

    There are many reasons why people should get direct access to their lab and diagnostic test results. Here are a few:

    If it’s your body — and I assure you, it is — then you really have a right to get the results sent to you directly. Most of the time you’ll have no trouble understanding what you’ll see. Almost always, at the very least, you’ll be able to figure out if it’s good new or bad news. Most of the time you’ll learn far more, and, with a little homework, understand a lot about your body that you might not have known with just a “no worries” postcard or a voicemail message that says “you’re fine.” On another level, why should the person responsible for paying for the test and the individual with the greatest interest in the results (i.e. YOU) be the last to know?
    Getting your hands on the actual results reduces the chance of errors. The report is less likely to get overlooked if you receive it and read it.
    Having the actual test result report allows you to add it to your own file so you’ll be able to maintain a complete record of all your healthcare tests, from all the specialists, urgent care centers, emergency departments and other places that analyze your body. You will, I promise you, end up having the only complete record of your tests on planet Earth. Should another healthcare provider need to see your past history or if you’re curious and want to make comparisons to previous tests, having your own copies will save you a great deal of time on the phone and some copying money, too.
    Waiting for test results can be hell. I got a mammogram two weeks ago and insisted on getting my own copy of the actual report from the radiology center. I got it in two days. I’m still waiting for that call or postcard from my doctor’s office.
    Getting the report gives you time to formulate questions and review the details before you’re half-naked and cold, sitting on a firm exam table in your physician’s office with a waiting room full of people eager to be seen.

    To learn more, visit my blog at bodboss.com.

  4. Barbara Bronson Gray, RN, MN says:

    I disagree with Dr. Val. Here are 5 reasons why:

    If it’s your body — and I assure you, it is — then you really have a right to get the results sent to you directly. Most of the time you’ll have no trouble understanding what you’ll see. Almost always, at the very least, you’ll be able to figure out if it’s good new or bad news. Most of the time you’ll learn far more, and, with a little homework, understand a lot about your body that you might not have known with just a “no worries” postcard or a voicemail message that says “you’re fine.” On another level, why should the person responsible for paying for the test and the individual with the greatest interest in the results (i.e. YOU) be the last to know?
    Getting your hands on the actual results reduces the chance of errors. The report is less likely to get overlooked if you receive it and read it.
    Having the actual test result report allows you to add it to your own file so you’ll be able to maintain a complete record of all your healthcare tests, from all the specialists, urgent care centers, emergency departments and other places that analyze your body. You will, I promise you, end up having the only complete record of your tests on planet Earth. Should another healthcare provider need to see your past history or if you’re curious and want to make comparisons to previous tests, having your own copies will save you a great deal of time on the phone and some copying money, too.
    Waiting for test results can be hell. I got a mammogram two weeks ago and insisted on getting my own copy of the actual report from the radiology center. I got it in two days. I’m still waiting for that call or postcard from my doctor’s office.
    Getting the report gives you time to formulate questions and review the details before you’re half-naked and cold, sitting on a firm exam table in your physician’s office with a waiting room full of people eager to be seen.

  5. Erica Steele says:

    I am running into that same problem myself patients wanting their labs without review. I perform functional tests that have nutrient recommendations. These are not literal and at times I load the patient for their liver to catch up, however I have a patient who wants to treat them-self. By giving them this lab this provides ammunition for them without me having truly reviewed it. Do I restrain and say that the labs will be released upon review or do I release them and hope for the best?

  6. Matthew S says:

    The doctor may have ordered the test but they are performed on the patient and paid for by the patient (or their proxy, the insurance company). Therefore, the physician, although ordering the test, has no ‘right’ to ownership on the results and as such no ‘right’ to review them before the patient. This is not to say that patients may need context with interpreting results but it is far to parental for the medical establishment to dictate such.
    Additionally, what of the tests that are never reviewed by the physician? Sitting on a desk or in an EMR awaiting a sign-off (estimate by some to as much as 7% of all lab tests)? A direct (or even slightly delay) release to patients would empower the patient to help ensure proper follow up is engaged.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

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Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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