How soon should patients receive their test results?

And should you assume that no news is good news?

The answer is no. According to a study in the Archives of Internal Medicine, 7 percent of abnormal test results from primary care offices were never reported to the patient. And in a large, unnamed, academic medical center, that number ballooned to 23 percent.

That’s almost a quarter of abnormal test results from that center that patients were never notified about. Talk about a malpractice time bomb waiting to go off.

Of course, practices with electronic medical records have the lowest rate of missed notifications, but interestingly, practices that combined paper charts and EMRs fared the worst of all.

Doctors receive hundreds of lab and x-ray reports, along with consultant letters and hospital admission notes and discharge summaries, each day, and it’s easy for a single result to slip through the cracks.

So, as a patient, if you haven’t heard anything one week after a given test, I would call your doctor’s office to follow-up on the results.

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  • Anonymous

    The most shocking point in this story is:
    “And in a large, unnamed, academic medical center, that number ballooned to 23 percent.”
    Why would this not be disclosed?

  • Vicky

    I agree, especially after undergoing some tests over the last six month and noting errors on the reports. For example a recent abdominal CT scan report read ” Note definite liver lesions” instead of “no definite liver lesions”, which no one would have picked up had I not requested a copy of my reports. Fortunately the latter interpretation is true and its a transcription error but the record should be corrected.

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  • K

    “So, as a patient, if you haven’t heard anything one week after a given test, I would call your doctor’s office to follow-up on the results.”

    And face the wrath of the medical staff. I find it easier to just request my medical records.

  • http://vendorMD.com vendorMD

    I think there should be a web interface for patients to check their own test results (of course with doctors’ comments on it in layman terms)

  • Carol

    My PCP emails a PDF of my labs to me – usually within 1-2 days – and adds whatever comments he thinks might be appropriate. Works great!

    There was one instance when I didn’t hear from him after a week and a half. I dropped him an email and got back a “Doh! I’m sorry – I forgot!” (literally) email from him that same day.

    I dread the day when, instead of just emailing the results, he calls and says “We need to talk”. That will be bad, bad, news, I’m sure!

  • http://oncallmedicine.blogspot.com Dr Jon

    A little perspective is needed as well. What is the definition of an abnormal lab value?
    Do you call a patient back for every abnormal lab value. Let me give an example. Potassium of 2.9, bad. What about borderline high labs. What about the patient’s with Hemoglobin of 11.9, that has been 11.9 for months, years?
    I agree with the commenter who suggested that patient’s be able to check their own labs online. Fantastic. Otherwise, a letter, generated autmatically, or email if preferred, is acceptable. These results should be first sent to the doctor, comments added when needed, and sent to patient. IMO

  • DS

    I have been in situations where specialists (pathologists) have called the patient by accident, instead of me (the referring physician), and as, reported by the patient, after identifying themselves, refused to disclose the test results. That leads to the patient calling my office, frantic, assuming that their test was grossly abnormal.

  • chuck

    Yeah, isn’t it amazing that a pathologist can’t talk to a patient, or a radiologist? Especially when the day radiologist overreads a discrepency from the night radiologist. Why can’t these guy pick up a phone and communicate with a patient?

  • http://www.mauigirlsmeanderings.blogspot.com Mauigirl

    Actually there is an electronic interface that some doctors are using – luckily mine is one of them. It’s RelayHealth.com. I can e-mail her through that system and she always gets back to me within 24 hours or less. If I ask about my test results she just posts the report along with her comments on it. For instance, one of my results was a tad low last time and in her comments she said it was not low enough to be of concern and she even looked back at a previous bloodwork report and noted that it had not changed since that time. To me, this is something that all doctors should be using. She also uses it to order prescriptions and transmits those on line as well to the pharmacies. It’s great.

  • http://MeyersmedMal.com Jimeyers

    as the data you quote does not address the more serious problem that many ordering physicians are not informed of ominous abnormal test results. Many of my clients over the years have been victims of such omissions. Most startling is the fact that a substantial number of these omissions are. Institutionalized. At one University Medical Center the the electronic medical records system was designed to assume that any lab report issued on the day of a patient’s discharge was reported to the patient’s floor before the patient was discharged. Though a report of results issued after 12:01 am the day after discharge was made to the ordering and attending physician, results issued after discharge but before midnight were reported to no one except the the medical record. A two year delay in the diagnosis of cancer and a very premature death was the case that brought this sys tem design flaw to the hospitals attention. The flaw had been present since the Systems inception years earlier. This is but one of many similar cases I have handled where as a result of policy, defacto or otherwise, catastrophic injries have occurred.

  • W

    My PCP always sends a letter (always the same format, electronically signed) with lab results. Always receive it about a week after the tests. The letter gives the numbers, indicates if they’re in the “normal” range, and if any are not, includes instructions to call the office. Works fine, and I have about 10 years’ worth of such letters for my own reference. I also find that watching the numbers gives me a little incentive to continue behaviors that seem to be having a positive influence. Can’t imagine why any doctor would not consider that important.

  • ray

    In Ideal world i think it is a must to call or send letter about labs. Some have patients do labs prior visits so they can discuss them in person. We will see 100% communication of labs if the doctor’s office got some credit for the time spent. Few hours are spent each day between patients by providers doing these things. The doctor who looks over past results and compares, puts in a pamplet about low cholesterol diet etc. Why isn’t this important detail not billed.

  • http://drgrumpyinthehouse.blogspot.com Dr. Grumpy

    I always call with results, regardless of outcome. I even tell patients that if they havent’ heard from me within a week to call and ask, because occasionally results get sent to another doc with the same last name, so I never know they got done.

  • misha

    I used to be ok with NO NEWS IS GOOD NEWS, but I am now trained to micromanage the health care providers (not so much mine with routine care…but for my kids when they are sick). I have a son who has urologic problems and you would NOT believe how many times the specimen for culture didn’t get sent or the records didn’t get sent to his specialist…or one time the specimen was spilled and the nurse told me it was negative instead of fessing up that it was actually spilled. I learned the hard way…by my child ending up in the ER and subsequently hospitalized for an untreated uti. And once I took my extremely cranky 14 yo daughter with general “i’m sick” complaints to the GP. Her physical stuff checked out OK, and he referred her to counseling. TWO WEEKS LATER, (I was forcing her to go to school, activities,do chores this whole time) the NURSE called me to say they failed to call us with the lab result that daughter had MONO. Yes–I follow up. The good news is that I moved to a new town where the practitioners are EXCELLENT. They communicate with us and with specialists and they LISTEN. I don’t feel the need to micromanage and I trust the system.

  • ninguem

    Never, never, NEVER assume no news is good news. It’s too easy to drop the ball. Not just the physician, but the patient.

    They fail to update their address. I ask the patient rhetorically. “Do you have a teenage son? How’s that son about passing on phone messages?” Mother invariably rolls her eyes.

    There was a news article a few days ago, about how many hospital pages go astray. The staff pages a doc who’s not on duty, that sort of thing. Hospital staff seems convinced that paging systems are magic and infallible, I swear.

    I know in training, I personally pointed out that certain parts of our major University teaching hospital were dead zones for the hospital’s own paging system. We had near-misses. One resident got in serious trouble for not responding to pages from a department chairman. Chairman would not listen to reason when it was explained, another part of the bureaucracy had to intervene to save resident’s career. I know I had to manage a disaster on my own, with help from junior residents, when attending could not be found. Fortunately, successful management of disaster, but same chair wanted heads to roll. As in, mine. I demonstrated good-faith effort to find attending all over the complex, overhead pages, sent a couple medical students out to usual suspected places, call rooms and all that. Attending was legitimately in the dead zone part of hospital. Fortunately, I survived that storm, and affected patient did fine.

    Not to point fingers, just that there’s a whole bunch of ways to drop the ball on communications. Paging, phone, E-mail, nothing is perfect, so I categorically tell patients NOT to assume no news is good news, and ALWAYS call our office if they receive no news within a week.

    By pointing out all the ways the ball is dropped, the patient does not usually feel so bad if they don’t hear back, they just call and we make sure they know the results.

  • cptmac22

    I take my tests, including CT, in the morning and 4 hours later I meet with my doc about my results. No panicking wondering about the what ifs. I like being in the same room as we look over my test results and our next plan of action.

  • MarylandMD

    I tell all my patients to expect a letter from me detailing the results of any tests I order. I also instruct them that if they don’t hear from me within 2-3 weeks, they should call the office and ask for their results. I tell them to do the same for any specialists they may see and to NEVER accept the “no news is good news” line, as that is garbage medicine. The vast majority of letters are printed out the same day I receive the results.

    All that being said, it would be good to look at what is defined as an “abnormal test result” in the study. Are we talking about a Hct of 27 or a very slightly elevated BUN in a patient with a normal Cr and no history or risk of renal disease? Everyone would agree the former is truly abnormal, but the latter is of extremely doubtful significance and I don’t know anyone who would inform the patient about it. I have never actually measured it, but I would guess that a few percent of the “abnormal test results” that cross my desk are in the latter category.

  • MarylandMD

    I looked up the study, and I have to say that how they define abnormal is reasonable. For example, it was expected that patients be informed of any abnormal Pap, abnormal mammogram, or positive FOBT within 90 days. Other examples: patients should be informed within 90 days of total cholesterol >249, K 5.5, A1c > 8.9, or transaminase >=2x ULN. Some exclusions were applied, so they did not expect you to inform a patient of a high AST if they had a documented history of chronic liver disease.

    This study should prompt physicians to take a hard look at how they manage lab results in their office (we should all periodically do this anyway). A significant delay in informing the patient about important abnormal tests puts patients at risk and significantly damages the trust patients put in their physician. It also puts the physician at significant medicolegal risk. Unfortunately, it is that last point that puts the most fire under providers to fix a broken system.

    This is a link to the study (which is available as a FREE full text article!):
    http://archinte.ama-assn.org/cgi/content/full/169/12/1123?home

    This is the link to the table which delineates what labs they were looking at, exclusion criteria, what they defined as “abnormal”:
    http://archinte.ama-assn.org/cgi/data/169/12/1123/DC1/1

  • Guest

    In addition to be notified of results, patients need to make sure that they understand the significance of those results. Physicians need to be aware of the importance of followup and to impress that importance on the patient.

    I’ll give an example. I’m caring for a patient with cancer. Looking at her previous hospitalization records she had been in a hospital at a previous time, and a report stated that the patient needed a followup scan, after 6 weeks, to determine whether the abnormality in the scan was benign or concerning for cancer. I don’t know if this was ever communicated to her, but she now has inoperable cancer in the site of the previous abnormality. Whose fault is this? Perhaps we can blame the patient, but I think it’s a problem with explaining the significance of findings to patients, especially patients with limited health literacy.

  • Family Doc

    For those of you who are able to get letters to patients so quickly and routinely, how do you do it? Do you have an automated system? One problem I run into is that most of my patients’ phone numbers are not in the computer system correctly, or they’re not there when I call, starting an endless chain of phone tag. It takes me hours each week just to write and send letters to people with abnormal results. I’d love to hear how you do it.

  • Cassie

    Over a year ago, after my yearly exam, my then-GP’s office sent me what turned out to be *part* of my lab results with an unfamiliar test listed and an ambiguous scrawl ‘for follow-up, looks normal.’ I called and faxed the office numerous times only to be told I would have to drive back (50 miles) to find out what this meant. I was extremely busy at work and don’t drink, so forgot about it–though I was generally feeling exhausted and ‘not good.’ (She generally blew off such reports or asked pointedly ‘if I was having the symptom now’..which should have told me something.)

    A few months later, my (wonderful) allergist, having actually listened when I mentioned increasing and strange symptoms, sent me for more in-depth labs. It turned out that I have a couple of serious and rare autoimmune diseases. There followed a round of visits with specialists, so I requested a copy of the GPs labs again and was shocked to see the extremely elevated liver values that had not been sent to me earlier. From what I can reconstruct, after seeing those values, she had the lab do hepatitis tests and based on those decided no problem.

    When the AI specialist saw those labs, she retook them (still well above average though not as high as before) and insisted I see a gastroenterologist. The first time I saw him, he scrawled something on a prescription pad and as he handed it to me said, “Here’s your first script–get a new GP.” Turned out one of the (rare) conditions I have is an autoimmune form of bile duct (and ultimately, liver disease) which I guess my GP hadn’t heard of. Apparently, though looking just fine and dandy, I could have dropped dead had the disease been more advanced than it was.

    I have since switched to a new GP who’s been very kind about answering questions by e-mail if they don’t call for a visit; and I take care not to over-do that. As for my (revered) gastroenterologist, I can communicate questions or concerns via his great assistant on e-mail and I’m fine with that; he’s a busy guy, gets a lot of referrals and this way he can spend time with someone who really needs it vs. having it tied up for a simple question. Both doctors (unlike my former GP) give me test orders before any scheduled appointments so they have the results by the time I see them, which saves everybody time. My gastro sends a copy to me ahead of time of the full results, and handwrites comments and interpretations–I was very touched when he took the time to compare recent results with prior ones, line by line, and commented enthusiastically “improved!”

    So…as far as sending results and any value-added comments to patients — yes, please. Nowadays the results are laid out in a way that patients can at least see if anything is seriously out of the normal range. If they have a chronic condition, they have probably educated themselves about what they need to know right away vs. waiting for the next appointment. If they don’t care, they can just toss them.

    But from my own experience, how this is handled reflects more generally the physician’s respect for their patients–and though I am sad to find out I have these issues, I am glad now that I have physicians who are true partners in helping me get the most I can out of my life.

    A postnote: Specialists along the way sent copies of their labs to the original GP. Maybe 6 months after I’d tried so hard to reach her, she left 2 or 3 nervous messages on my VM asking how my liver was doing. I didn’t respond because ‘it is what it is’ but neither did I want to waste my time, since I had the distinct feeling she was more worried about a lawsuit than my life.

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