Most prefer the bottom line, sparing them the raw data.
Primary care physician Rob Lamberts asks that exact question, and reprints sample reports of lab tests and an echocardiogram, demonstrating the wealth of information they contain.
So, borrowing this image from Dr. Rob, I’m not sure how useful something like this would be to patients (sorry for the small type, but you get the idea):
Much of the data is not relevant, with the abnormal results in the range of lab error. Many patients won’t know what to do with these numbers, although I can appreciate the few who are diligent and enter such values in a spreadsheet so they can track it.
So, when you consider that the amount of time a primary care doctor is able to spend with patients is shrinking, does it really need to be filled up by questions generated from essentially normal lab reports?
Alas, as you can see from the comments generated by Dr. Rob’s post, there’s no clear-cut answer, as some prefer to receive the raw data, while others simply want the bottom line.
If there was an efficient way for patients to make their preferences known, that probably would be the best solution. However, considering I review hundreds of lab tests daily, there’s no way I can keep track of how much detail an individual patient would want in their lab reports.
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Let’s ask this question the other way. Why SHOULDN’T patients be given the results — along with a sheet of paper, or a link to a website, that tells them what it all means? Then you’d have a bell curve of responses. At one end, some wouldn’t care at all, at the other, patients would analyze every number there. But if you gave them access to interpretive information, they would become more engaged and more responsible.
Why do you assume you would have to interpret them all in person? I do understand that (in particular primary care) doctors feel squeezed for time, of course. So consider enlisting technology, or at least paper, to help you out — and share those results!
Reading between the lines…the question is, do busy, overworked doctors want to take the time to explain, in detail, test results to patients? We should take the time and do it right. Give your patients a little credit, it is really not that complicated. Explained well, they will get it. Remember, “You do not really understand something unless you can explain it to your (a) grandmother.”-Einstein.
So just give them what is theirs, the full document which has the results you have used to evaluate them.
Having had doctors ignore and fail to mention or address frankly abnormal results, relevant to my reason for appearing for testing in the first place, I don’t have much sympathy for physician who decide it’s too much trouble to explain he has reviewed the data on the form , and what he has drawn from them.
I have a few patients that want copies of their entire labs. Then they call and want to talk on the phone for an interpretation. I already sent them a letter summarizing my findings of course, but they want to talk about each individual line. They need to make an appointment and it is a time based appointment. Time is money and the only thing I am selling is my expertise. If you want my time then you need to pay. If I was to spend all that time on the phone for free, then I would be looking for new job.
As a patient (and medical librarian, too), I want the originals of my test results for several reasons, but the most important is because I sometimes need to share it with another health care provider and it’s easier for me to bring it with me than to ask for a copy to be forwarded. Luckily for me, my current doctor automatically mails me copies (with an annotation) so I have them without asking.
NOT RELEVANT??? Even a Gas Passer like me can see the patients got Mono, an elevated MPV, whatever that is, and is just a 50 cent MARTA ride from Dialysis…. and her CO2’s low, probably better give her some Bicarb…
and you call yourself an Internist…..
Frank
As a healthcare risk manager, I have seen far too many liability claims in which a physician overlooked a significant finding, to the detriment of the patient. Accordingly, I request copies of all my diagnostic studies, just to provide another set of eyes looking at them.
I’m with steersbylitning. I want my full reports in my own file, annotated by my physician or not. Not only are those reports invaluable for reference and for other docs, but two primary care physicians have retired on me in the last decade, sending my records into some medical sinkhole when they left.
For many good reasons, I keep records on car repairs, home repairs and want to keep similar notes on my own body work.
I guess I don’t understand the worry that patients will pester docs on the phone. Every practice I go to includes many layers of protection between patient and physician. I can’t imagine ever reaching my doc on the phone for any reason at all, let alone educational purposes.
“If there was an efficient way for patients to make their preferences known, that probably would be the best solution. However, considering I review hundreds of lab tests daily, there’s no way I can keep track of how much detail an individual patient would want in their lab reports.”
Computers are wonderful tools. Any database can have radio-buttons added so that every patient record states whether the patient wants full-results, summary-results, only-if-abnormal results, or whatever other options there are.
I tell all of my clients to get copies of all of their labs and scans. You would be amazed how often charts get lost. I’ve seen dozens of cases where a chart went missing between hospitals and that patient’s personal notebook of scans and tests became a life-saving tool.
Patients must acknowledge that they are general contractors hiring subs, or relinquish subcontracting decisionmaking to the generals they hire.
Patients must accept that times have changed, actuarial tables established at Medicare’s inception are obsolete, and the fate of individual corporeal existence is the patient’s own responsibility.
Acceptance of responsibility is frightening at first, then liberating.
To get (government, ‘big insurance’, ‘big heath’)intervention removed from power over individual lives, individuals need to assume personal responsibility.
So: give all data to patients. They (or their estates) cannot later claim information was withheld. Charge a cash consultation fee, if explanations are sought, or reinvent the medical practice as higher-margin, lower-liability ‘life coach’.
Frank,
Monocytes do NOT mean mono. A monocytosis (high monocytes) can be from a hundred things including renal failure. That person does have renal failure but is far from dialysis at this time. The MPV being high is minimal. Not important. If I had to do this for every test I ordered I would only see about 5 people per day. It would take too long to do this for everyone.
If you all want a reference for yourselves then go here:
http://www.labtestsonline.org/
My cancer diagnosis was delayed by two years because of gross errors on the part of several physicians. Doctors are human, they make mistakes, sometimes huge ones, particularly with time constraints imposed by current reimbursement schedules.
Yes, I want copies of everything. Questioning a doctor on some finding that might have been overlooked could potentially save a person’s life, or at least give them the possibility of cure. Or, best case scenario, assure them that nothing has been missed. Lesson learned the hard way.
Having copies also makes going for second opinions easier as there often are long delays with records requests.
Labtests online is a great resource.
I got my last test series back (I was changing insurance), and noticed some odd results. Called. Spent a week waiting for a call back. Asked doctor “do I have a UTI?” Clicking as computer is checked. “Oh, yeah!” I had no symptoms other than a fever I hadn’t noticed. Lucky timing on the test and the fact that I got the results might have saved me from something worse. So don’t assume doctors read the results they get. Sometimes patients have to do it. The doctor still hasn’t noticed/mentioned that my cholesterol is 259.
stargirl65, you got “had” by Frank….pretty sure he was being sarcastic.
As a patient, I’d prefer to get both — a summary of the doctor’s observations in front, with the full results attached behind.
All my patients get their visit note mailed to them, which includes the labs. I’d like to email them a PDF but the legal gurus haven’t approved.
I like trying to figure this kind of stuff out. I am curious about a lot of things in medicine.
I agree with stargirl65. As a primary care physician, i already spend over 10 hours/day seeing patients, working on the paperwork to get different medications or tests approved, managing patients’ diabetes/hypercholesterolemia/hypertension based on the nursing visits that occurred that day. I have no problem sending patients’ their full lab/test results with a little paragraph or sentence at the bottom with my interpretation. But if they want further information or clarification (especially if I thought all was normal), I expect them to make an appointment with me. I will not give up more of what time I get with my family to discuss lab results that are just slightly outside of the bell curve.
Oh and that 10hrs/day does not include the time I spend at home reviewing things on the computer (thank goodness for EMR) after my kids have gone to sleep.
Compare posts #7 and #17. A risk manager recommends reviewing the full labs…a doctor is not allowed by risk management to e-mail them to patients.
The idea that risk management might interfere with access to my own health information is pretty irritating. I assume it’s the electronic transfer that’s the issue. Fine: Any patient who requests/buys the paper records has to sign a waiver. So just modify the same form for e-mailing pdfs. What’s the problem?
More Rx, less CYA…
You didn’t read carefully enough. My patients DO get all their labs. I want to provide an extra service to those that would want it but our lawyer (a young progressive guy who thought it was a great idea for both patient satisfaction and financially) when asked if this was Kosher with HIPPA (not if it was opening us up to risk) said they read it as a violation while post mail or fax is not. I may think it’s ridiculous but obeying federal law isn’t CYA. If you don’t like it, please get your representatives to write better laws; I’m sick of being hamstringed by silly laws.
I get copies of all my reports for three reasons.
1. I have a rare disease most doctors would not know enough about (if they knew of it) to diagnose it in a patient. 2. Because I was misdiagnosed (see #1 above), I had a stroke which has compromised my memory, so all the discussions in the world with my doctor do not follow me home intact, and having the info to read helps bring that back.
3. If I have an event and need to go to the ER, I can provide them with the most recent consult letter and reports so they can take care of me and order the appropriate tests, as most doctors don’t seem to take the word of the patient.
Seems like a win-win to me! Being a doctor is hard work, being a patient who is not listened to when they know something is terribly wrong, even harder and the fall out is for life…
I really appreciate patients like YATYTHAHA. Makes my job easier and their care better.
I tell all of my clients to get copies of all of their labs and scans. You would be amazed how often charts get lost. I've seen dozens of cases where a chart went missing between hospitals and that patient's personal notebook of scans and tests became a life-saving tool.
NF: I read your earlier post closely enough to understand that you were getting complete information to your patients despite being unable to use e-mail, and I considered your patients lucky to have you. I did not understand that your lawyer also would have supported the practice — also commendable. Perhaps he can still find a way around his resources’ interpretation of HIPAA. No, I do not appreciate government interference in the doctor-patient relationship, any more than I appreciate the meddling of attorneys less wise and compassionate than yours. Have a good day.
Chiming in again as the risk manager: there are indeed legitimate HIPAA concerns that can arise from emailing PHI to patients. Most practices do not have the electronic security measures in place to allow this to be done in accordance with the regulations. There has as yet been little case law interpreting the regulations so most people are being very cautious about potentially running afoul of the electronic security requirements.
I personally am a fan of using a secured website to allow patients to look up their labs. This is an approach that has generally passed muster. I usually only see this in the larger clinics or health systems that have the necessary IT people on staff to implement the security measures.
Interesting story on MSNBC today on the issue of tests falling through the cracks: http://www.msnbc.msn.com/id/32490265/ns/health-health_care/
I am going to have to read the Archives article as well. Neither the findings nor the recommendations in the MSNBC article are new to me.
I’m a DVM and I have absolutely no problem reading my own laboratory and radiology reports. I vastly prefer reading raw data myself to discussing findings with the average MD, which is generally redundant and frequently useless. Sure, there are a few species differences, but in my experience, I haven’t needed to ask an MD to look up any “big words” for me. Actually, because I’m accustomed to taking species differences into account when interpreting test results, I’m better equipped to read my own test results than the average MD is to read his or her animal’s test results (yes, I am dead serious).
I find this entire issue to be ridiculous. If my clients want their test results, I hand over a copy; if a client has questions, I answer the questions. It takes 5-10 minutes but I want the client to understand… after all, s/he paid for the tests (already).
It is policy that we always set a follow up appointment when scheduling labs. The labs are always explained in detail and the patient is given an update on their progress from previous lab, then they are given a copy to take home. At the time of lab follow up all other chronic disease and medication is reviewed and adjusted accordingly. This not only tends for great patient satisfactionand better compliance, but is what primary care should be about, the patient centered medical home. It takes less time taken from staff and physician explaining over phone for free. (Ma’am your lab is normal,….”but what was my cholesterol last time I got labs?”….etc.) Most of the time we get a level 4 billing from those visits because of the comprehensive follow up and education on all of the different issues covered and can usually do all of this within 20min. We always do this at time of annual physicals as well, with their chronic issues as carve outs.
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