Lab results: "No news is good news" is the worst advice

in Uncategorized | 16 responses

A patient expresses frustration and how her doctor reports lab results. His “no news is good news” philosophy is terrible advice. Physicians review several hundred lab, radiology and consultants’ notes per day. There will be times where abnormal values slip through the cracks.

Comments

Anonymous
So what constitutes a reasonable amount of time?
I always call if I haven’t heard anything within seven to 10 working days (I figure weekends and holidays shouldn’t count). Most of the time, the reaction I get from the physician’s nurse is one of annoyance that I’m bothering her. I’m not sure if 7-10 days is too soon or if she just doesn’t want me calling, period.
It’s important for patients to take some responsibility for following up on their tests, but it’s frustrating when this is the kind of reception you get.
I feel we’re damned if we do and damned if we don’t.
Rich, MD
I always recommend 1 week unless there is something urgent or I am requesting STAT results.
I understand that calling a physician’s office can be frustrating, and while in my office we make every effort to be accomodating (and we expect these phone calls) I am sure that at times someone is having an off day, or is overwhelmed, etc., and the office staff probably has just as many stories about irate calls (I could write a book about things people say on the phone). I can’t speak for other practices, though.
If your experience is consistent, you should tell the doctor (who may not know his staff is unpleasant with patients – it happened to me – and I found out only by accident) and if the doctor is unresponsive to your concerns, than the nurses behavior probably reflects the doctor’s attitude – try to find a new one.
But I disagree that you are “damned if you do and damned if you don’t”… I would trade the unpleasantness of a brief phone call for a missed abnormal lab any day. Annoyed if you do, damned if you don’t.
Diora
The medical group I go to notifies either way and let you know when to expect the results. I usually give a couple of extra days and then call if I don’t hear anything. Only happened once though and for a non-urgent test (bone density).
My manager was complaining once at lunch about how his doctor’s office tells him “if get a letter from us, everything is fine”. He told them “yes, right, either that or the letter got lost in the mail”, and asked when he can call for the results.
Anonymous
I agree with Kevin. This is horrible advice. I actually tell my patients to NEVER assume that no news is good news. If they don’t hear from me, they should call me, becuase it means that I never got the results. A letter or call goes out for ALL results, normal or abnormal. I have signs in all of the exam rooms stating that patients should call if they are not notified of results in 2 weeks. Of course, that doesn’t stop many people from calling the day after their lab draw…but I’d rather deal with that minor annoyance than with the potential consequences of a missed result.
Anonymous
The signs in the exam room is a BRILLIANT idea.
a)reinforces to the patient that this is their responsibility and that it’s okay for them to call.
b)serves as a reminder to the pt
c) gives some idea of the timeline for when to expect test results. Some offices it’s one week; others it’s two weeks; cut us some slack, we don’t always *know* what a reasonable amount of time is for your particular practice.
d) reinforces to staff that this is expected behavior on the part of the patient. So when we call, it is regarded as our effort to be responsible vs. pestering the staff (as the second anon. poster said.
I’d like to see a better way of explainng the actual test results too, instead of a vague “it was normal.” It’s like having pt come into your office and say “I’m sick.” It tells you NOTHING.
One challenge at a time, tho, I guess.
Anonymous
I’m the anon who posts the signs in the exam rooms.
I agree that a vague “it’s normal” is not sufficient info. I have a pre-printed lab result form that I send out. On one side, I check off which labs were drawn and write in the result. On the other side, I have an explanation of what the labs were and the “normal” ranges. I also have an area to write in any comments that are necessary. I don’t use that area that much because I call the patient with abnormal results or make them come in for a visit to review them.
Anonymous
When labs are draw as part of a preventive vistit, I tell my patients they can call in for results if they don’t hear.
What does bother me, though, is when patients come for a specific issue that is going to require follow-up, and I instruct them to get the tests and schedule a return visit, then one week later they are calling on the phone for results. My policy is that if you are directed to make a follow-up appointment, then test results will be discussed in person at the follow-up.
Of course if something emergent turns up in the meantime I will call them. And if someone never bothers to return for f/u and there’s an abnormal result we will eventually try to contact them by phone and mail.
Anonymous
My ob/gyn has a policy similar to this posted in his office. It states that all test results will be discussed at the time of the follow-up visit and not to call in to get your results by phone unless you were told to do so or didn’t need a return appointment. They always mail the routine PAP results within a few weeks. Its worked out fine for me.
Anonymous
I had a GYN once whose standard advise following the yearly pap test was always…”If you don’t here from me, I’ll see you next year.” That isn’t good enough.
I went once when I was in my mid 40s but I was also having some problems. He assured me these problems were pre-menepause issues and I was fine.
After 3 weeks when I hadn’t heard from my pap, I called the office. His office girl was RUDE. She told me “Well if it’s been 3 weeks an dyou haven’t heard anything then that means it was normal.” I told her “well, amuse me and look them up anyway.”
She was gone forever and then it was the RN who came back on the phone. It seems they were not normal and I needed a colposcopy and biopsies, the next day. Those results were invasive cancer! I was sent to a concer center as a result of those biopsies. The bottom line is my Doc. had never seen these results. Until the day I called.
So yes, we do have a repsonsibility to follow up on test results. Although, I agree that these Doc’s office staff should be better trained in customer service.
Anonymous
My policy is that if you are directed to make a follow-up appointment, then test results will be discussed in person at the follow-up.
Have you ever thought that the reason people might be calling you is because they are worried sick and going crazy?
It depends on a specific problem, but if it is something that could be serious, uncertainty is pretty stressful. Waiting for the appointment adds extra days of anxiety. In some people, this causes blood pressure to go up, so it causes physical harm as well. This is especially true when they call you to make an appointment because then you assume it must be something bad.
Worries about health matters have a tendency to consume your life. You try to go about your business but the tests results are always in the back of your mind. There is always this nagging feeling.
Different people handle it differently. Some can stay calm, other are going crazy, not being able to sleep or function normally. I think doctors often underestimate the harm extra anxiety may cause. What is wrong with just instructing the nurse to give a quick summary and discuss the details during the office visit? Stress can cause real physical harm.
MRM
On the Voice mail system that my family doctor uses, there is an option for asking about test results. You leave a message, and the recording says they will call within 24 hrs. This keeps patients from having to talk to the clerk who’s handling appointments, or taking patient copays, etc.
Several years ago, a specialist Dr. S sent me for bloodwork. He told me to call his office the day before my followup appt., to make certain the results were in my chart. The clerk who answered the phone, when asked about the results, said “How should I know if they’re here.” I informed her that Dr. S had requested that I call the office. She got off her ass and went to look for the results.
Which taught me a lesson – if at all possible, work a doctor’s name into your request for test results. Such as ‘Family doctor is sending me to see Specialist. Specialist’s office requested that I bring my most recent bloodwork to my first appt. Have the results arrived yet?’
Still, I prefer the phone option for leaving a message for results. It’s more upfront, and guarentees there a system in place for a clerk to find the results and call you back.
Anonymous
I had a dermatologist’s office leave me a message late on a friday afternoon telling me it was very important that I called them back to discuss my biopsy results. Then, they left for the weekend. I was worried sick all weekend thinking that I had melanoma or something. Not good to leave an urgent message on an answering machine on a Friday afternoon, with no way for the patient to contact someone. That really sucked.
Anonymous
I’ve never understood doctors’ offices calling on Friday afternoons and leaving messages to call back. Especially to home numbers, when we are at work and will not get a message until the evening.
A friend of mine had a similar experience. It’s been a little over a year since she had radiation and chemo for cervical cancer, and she was waiting for her pap smear results to see if a year later she was still cancer-free. They called her on Friday afternoon and left a message to call back. When she did, there was nobody around who knew anything. The person she talked with told her “well, with your diagnosis you should know that anything can happen, so why worry?”.
The whole weekend she was absolutely frantic. She called me and another friend and we tried to reassure her that everything might still be OK, but she was absolutely sure her cancer was back. It took her most of Monday to get a hold of anybody who could tell her the results. Finally, by Monday evening she found out that they were normal. If they are not allowed to say “everything is fine in the message, would it kill the office to call on Monday?
Do doctors know that stress is bad for us? There is something almost sadistic in calling on Friday afternoons or in refusing to give any hint of what might be going on until the appointment.
MRM
Yeah, I’ve had the late Friday afternoon phone-call-of-doom. At 4:30pm, family doctor’s office calls to tell me that I have to come in to discuss my recent bloodwork. They have a 1 o’clock appt. on Monday, can I make it?
“What’s wrong?” I plaintively ask. “The doctor will discuss it with you on Monday,” replies the clerk in an ominous tone. I couldn’t get any more info out of her, and the doctor had already left the office for the day.
I spent the weekend thinking it might just be something like diabetes. Or maybe a liver problem. Or anemia. Or leukemia. Yeah, maybe I’m one of those people who feels perfectly fine, but has a lethal disease.
Come Monday, 1:00pm. The sole problem was that my TSH was slightly lower than the normal range. This was the grand emergency? This demanded a next day appointment? Even the doctor apologized, unprompted by me. Since I’d already shelled out a $30 copay, I used my alloted 10 minutes to discuss another problem.
Doctors should advise their staff to NOT call patients on a Friday afternoon with serious news, unless the doctor is still in the office to discuss it. And no leaving messages on a home answering machine. There’s often a cell number or work number in a patient’s chart; why not use them. Unless it’s absolutely dire that the person seek immediate medical attention, leave the phone calls till Monday.
The one exception I can think to this is if a patient has already called requesting test results.
Diora
My own experience with Friday afternoon call was also about the bloodwork. Usually they just leave a message “everything is fine, call us if you have any questions” and send me a copy of the lab report for my information. This one time the message asks me to call back except for of course by the time I got home from work the office was closed.
I spent the weekend googling trying to find all the things that can go wrong on a routine blood test. I figured since they have a permission to say anything they want in a message on my answering machine, and since they’ve done it in the past, it must be something serious.
Monday comes, I call the office “the doctor went on vacation and is not going to be back until next week, the nurse is also on vacation, we don’t know anything…”. I got a little upset and let them know how anxious I felt, so they told me they’ll try to locate somebody and call me back. Eventually they located a nurse which told me that my LDL cholesterol was slightly higher than the number in the guidelines. How nice of them to worry so much about my heart – the stress of this weekend certainly did wonders for it.
What really bugged me was not even the fact that they did have my work number and permission to leave messages with details on my answering machine, but that they could’ve easily waited till they are back. I didn’t expect to hear from the office for another week or so, so they could’ve easily postponed it until they got back from vacation. It’s certainly very sensible to say “please call us” when you know that nobody would be to answer this call for a week.
Asolutely agree with the poster above on “no calls on Friday that require a callback” policy. Also the doctor above who is upset with patients who want the results before the appointment should get one of those calls himself about his own health and see how patient he’d be.
Anonymous
You have all opened my eyes … I was always told no news was good news, and went with that. I just got a call today from the Dr office telling me that she wants to discuss the results of my pap test I had done over a month ago … I had assumed they didn’t find anything since so much time had gone by … fortunately I can go in and see her tomorrow morning, but of course you know I am researching like crazy or I wouldn’t have found this page .. the stress is so difficult to deal with right now.
Next time I have a test .. probably in 3 – 6 months from now, from the research I have done today, I will make sure I call 2 weeks later to see if they have the results … I am not sure if it just takes that long up here in Canada to get results, as I don’t remember it taking that long about 10 years ago when I had an abnormal result … I never got a call about any other test as they only call when there is a problem, and I always assumed after about 2 weeks that I would not be getting a call.
Keep your fingers crossed for me