The empowered patient is a relief for physician practice

Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means patients may access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.

Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than a “no news is good news” approach to reviewing labs with patients. Or they stamp the lab report “normal” as long as they do not fall outside of the gigantic reference ranges the labs have set. So patients do not get to see how “normal” they are or how things have trended in the past. This means that patients who are not contacted are left to assume things are “fine.” The data shows that 20% of labs are lost and not reviewed by physicians and so patients sit at home believing things to be okay when that may be far from the truth.

The blame should not be placed fully on physicians. Often, they are overburdened by having to maintain a busy day of patient visits in order to generate revenue for the practice and keep the doors open. They still need to spend a significant part of their day doing things that do not pay the bills or bring in revenue to pay their staff: reviewing patient messages and questions, reviewing consult notes on their patients, and the expectation to review every lab, test and procedure on their patients. With this much on their plates, things are bound to be overlooked or just flat missed. This is a system issue, not a physician issue. A healthcare system that only rewards patient visits means two things happen with labs: either you meet face to face with your doctor, you get the “everything looks fine” from their staff, or you just get flat ignored.

Enter the patient, who is starting to understand the vital role they must play in their health. It’s up to them to navigate their path. Now, they’re helping to play a role in determining which therapies or lifestyle roads are taken, interacting with their provider to maintain a regular relationship, staying on top of regular monitoring and screening and now controlling their data to ensure things are on track.

There are few systems and practices that are supporting the enabled and empowered patient well. More and more physicians are realizing that the empowered patient is actually a relief for their practice and not a burden. Their questions are more focused and appropriate, they stay on top of their labs and screening so you don’t have to, and generally they are making better lifestyle choices to increase the health of themselves and subsequently your practice. It’s time to truly embrace them and provide them with tools to connect with you and attract more of them.

Jeffrey Gladd is a family physician specializing in integrative medicine at GladdMD Integrative Medicine.

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  • Jake the Snake

    When my dog has blood drawn for lab tests, the veterinarian always calls me with the results, and discusses them with me.  He doesn’t charge separately for this telephone call-he treats it as part of the office visit with my dog that I have already paid for.  When I see my physician and he orders lab work for me, why shouldn’t reviewing the results and discussing with me (by telephone, or perhaps email) be considered part of the office visit that I have paid for through my insurance carrier?

    • Anonymous

      Which insurance company paid your vet?  Oh, there wasn’t one?  So the vet was able to charge what he/she felt was appropriate, up front, to cover this time he/she spent with your pet and with you?

      Please don’t think that the insurance company just takes your money and turns around to give it to the doctor.  My insurance payments went up about 2-3% max this year, but my insurance costs to cover my employees went up about 9-10%, and with fewer benefits.  I think that says something obvious about insurance companies.

      I do call some patients with results, but it has to be something very serious or requires complicated changes.  Otherwise I tell my nurse to call and what to say, or type a brief letter.  I have about 20-25 reports each day, with varying numbers of test results from a few to many, and it takes me nearly an hour to go through those and make changes in treatment recommendations, usually sitting at my office desk from 6-7 AM.  If I called everyone of those patients, at an average of 5 minutes per patient (“oh, yea, doc, since I have you on the phone…”), that would be 2 hours time rather than one hour.  I can’t afford to lose another hour per day (that alone would equal another 2 and 1/2 lost days per month of not being able to see patients) UNLESS I can be the one who determines my fees rather than some insurance company.

  • Anonymous

    Are you saying you’d be content with a veterinarian’s salary?  Somehow I doubt that.

    Just send me my lab results, including the histopath.  I have no problem reading the big words.

    • Anonymous

      Most patients do not just want the lab results.  In fact, even though my explanations in my letter to the patient seem complete to me, I still have patients who schedule follow up appointments just so they can HEAR me tell them the results.

      What the vet is satisfied with in regards to his/her salary is up to them.  They at least have the freedom to set it.

  • Anonymous

    Perhaps we should have a discussion on what tools patients need and that doctors should be the ones highly involved in sifting through the tools to help make more empowering choices… not misinformed choices.

    • Anonymous

      We can do that when physicians figure out how to order tests appropriately, then review and interpret results in a timely fashion (20% of labs lost = disgraceful).  Oh, yes, don’t forget to remind physicians to regularly review current evidence of test specificity and sensitivity, as well as mortality and quality-of-life outcomes.

      In the meantime, just send me the results.  If I have any questions, I’ll make an appointment, but it won’t be with you.

      • Simon Sikorski MD

        I just came back from the Health 2.0 Conference in San Francisco. There were a lot of tools being discussed there PJ that will definitely help physicians save time and yet review all the critical information… so there is hope on the horizon. I understand your frustration, I was a patient myself at one point without access to my medical records … I would have loved to be part of the care team, instead of being treated like a “case.” I’ll be writing more on the Health 2.0 movement on my website: under the Health 2.0 Tab.

  • Haleh

    I routinely ask for copies of my lab results and encourage everyone to do the same.  It cuts down on mistakes and at the minimum allows the patient to ask some intelligent questions. 

    Haleh Rabizadeh Resnick is author of Little Patient Big Doctor: One Mother’s Journey encouraging doctor/patient partnerships.

  • Patient Commando

    Empowerment doesn’t require sophisticated tools or an extensive medical vocabulary. Let me explain.

    I was diagnosed with Crohn’s disease over 30 years ago. For the first 6 years I was in and out of hospital like a revolving door. I was on Prednisone and a host of other cocktails. I followed my treatment regimen. I had all the tests and investigations done on multiple occasions. And yet I was seemingly only left with a single option – surgery. Still, I hadn’t asked a single question in all that time.

    A friend serendipitously asked me “Are you ready for something different?”. I had nothing to lose. And with that question I was launched on the amazing journey I’m still on today.

    He introduced me to an alternative practitioner of chiropractic and nutrition. The type of practitioner doesn’t matter. What did matter is what he told me to do – get a pencil and a notebook and start documenting all of my symptoms and everything I ate. For the first time I became an active participant in my healthcare and not just the object of my healthcare.

    I’m not going to go into the details of the last 25 years of managing my Crohn’s. But I will emphasize that it only took a simple pencil to get me launched on the road to patient engagement.

    Zal Press

  • Anonymous

    Its not clear to me what the empowered patient is.  According to Dr. Gladd an empowered patient is the patient who can review the result of his blood or urine analysis.  I am nor denying that the secrecy of electronic health records allows such a review.  That brings me to what I would characterize as an empowered patient:  An empowered patient is an educated patient.

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