Patients who receive test results instantly: Doctors need to be ready

Patients are increasingly demanding, and understandably so, that since they pay for their medical tests, they should receive results directly and immediately without waiting for physician review or interpretation.  Recent articles in the lay press about this issue are accompanied by scores of online patient comments insisting that physician reporting and interpretation is too often unreasonably delayed, often inaccurate, or just plain unhelpful, so why bother waiting at all?

Dr. Google and other “reputable” online medical resources are always ready and anxious to be of assistance 24 hours a day when one’s own physician is incommunicado.  Hundreds of patient inquiries about interpreting test results and other concerns stream into medical websites that allow other physicians to answer back to an anonymous patient in order to build an impressive online reputation.  Suddenly a patient has access to dozens of opinions, possibly valid, often not, from other patients and professionals who do not know them, have never met or examined them, and have only part of the clinical information needed to draw any conclusion whatsoever.

So why bother even seeing a health care provider anyway?  These days, patients can purchase, perform and interpret results of certain lab tests in the privacy of their own home, can access for-profit screening imaging and scanning services without a physician order, as well as buy many of their own medications on the internet without a prescription.   Fewer are willing to navigate through a medical clinic telephone tree, then pay for a clinic visit, in order to wait interminably for the call back about results of testing.   They do not feel cared about or cared for so are taking matters into their own hands, without the training, experience and skills they need.  I completely sympathize with their frustration, but disagree they should walk this hazardous medical road alone.  There is a better way.

We physicians can and should provide better service in getting all test results back to our patients quickly. Every clinical setting is unique, but there is no valid reason why any result should not be communicated back to the patient on the day it is received, preferably within minutes.   In our clinic, we do not put off today’s work until tomorrow:  “same day scheduling” means the patient who calls today is seen today.  “Same day response” means phone calls, emails, electronic messages and all incoming testing results receive responses that day.  It is true some “later in the day”  lab and radiology results must be sent electronically in the evening and on weekends, often from a provider’s home, but that is the care commitment we make to our patients.  Not only does that allow us to respond quickly to a significant abnormal that needs follow-up, but it allows us to address the insignificant abnormality, reassuring the patient that we are on top of what is happening for them.  Any practice frequently sees labs and xrays with results outside of the normal standards.   The clinician who has seen the patient, has done the physical assessment, and is aware of the past history is in the best position to interpret and specifically address the significance and need for follow up of anything “out of range.”

The only way this can be done efficiently and easily is with a robust electronic medical record system with integrated lab and radiology results, along with a password secured patient web portal that allows that information to be viewed by the patient.

I’m an enthusiastic advocate of patient autonomy, providing as much information as possible as soon as possible.  The advent of patient access to instant electronic results necessitates that clinicians be ready to help stem the tide of confusing information flooding indiscriminately to the patient.   We need to be ready for the fear, the anxiety, the questions and even for the relief when things look fine.

After all, that’s what we trained to do. And we’re happy to do it.

Emily Gibson is a family physician who blogs at Barnstorming.

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  • karen3

    A point to remember. Most patients today are, defacto, responsible for their own coordination of care. Whether well or poorly qualified, this job has fallen to us. An abnormal test result that Dr. A thinks is now issue may be a big issue to Dr. B. If the patient has to wait a month to get the appointment with Dr. A to get the results, schedule an appointment with Dr. B, two months hence, with the appointment bumped off a couple times because the doctors cancel appointments at last date, it can be four or five months before that test result is addressed. Cycle time in medicine is important.

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for this post Dr. Gibson. It raises some interesting questions and I think some fears that will turn out to be unfounded. Here’s what I mean.

    When the secure patient portal is ultimately available, the patient will be able to see their results without seeing the doctor (or nurse), however you will decide when the results are released and will undoubtedly develop a system to connect immediately with all patients whose results are abnormal. You already have systems to do this … they are just offline and slow.

    When I log on and see my abnormal result and either a text from you (or your nurse) asking me to connect for further discussion … I am no more likely to google this result than I have done previously. Information does not flood indiscriminately to our patients … they go looking for it. And with this new method of communicating they can get that information directly from you more quickly than they have ever been able to.

    It is also important to note that this “secure patient portal” has NOTHING to do with social media – the rage of the moment in the healthcare consulting world.

    We live in interesting times. Keep breathing,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • http://www.facebook.com/xislandman Dennis Marshall

    In recent years I have had ‘must have expensive’ tests that weeks and in one case over a month went by without a call from either the doctor or his office with the results forcing me to run the gambit for myself. Unacceptable. I fired one doctor because his office files were full and records were piled high else-where. It was obvious the level of care was poor and for him, it was all about generating income.

  • http://www.facebook.com/carol.levy.336 Carol Levy

    The receptionist at a dermotologist’s office told me my biopsy was positive for cancer. I had waited over a month for the results and finally called when I heard nothing from them. I came in to get a copy of the report since she could not tell me what it meant only that it was positive. It stated basal cell but chance it was next level squamous cell. I am not cancerphobic but neither she nor doc could have known that. Results of any test, without context are meaningless.
    I was doubly surprised when the physician told me he had patients tell him they did not want to make an appointment or get the results directly from him. I found that extraordinary, that a doctor would be fine with a receptionist, with no medical training, relating what could be very bad news.
    If a patient cannot talk with at the least a nurse, PA or NP, or the doctor about results, it makes no sense to me to get the results to them quickly. It often creates more problems.

  • http://twitter.com/bergamotley Dorothy Pugh

    One thing I like about my current medical center is that it makes my test results available online very quickly. I also have the option of going through an online service to schedule tests at a local lab, and do that because these tests cost much less than they do at the doctor’s office. Since they go by standard “normal” ranges, I’m getting the same information as my doctor. In fact, I can predict with complete certainty from the lab report how the doctor will respond. Doctors don’t seem to go by clinical signs or symptoms any more (sometimes not even looking away from the computer screen at the patient), so what’s the use of going to a doctor if your test results are all normal?

    I think doctors can encourage patients to come into the office is to be responsive to the issues that they raise, even in the absence of abnormal test results. But at big medical centers, they’re on a very short leash, so that may not be practical.

    I’m glad, though, that doctors no longer have to spend hours repeating the process “translating” lab test results into an almost meaningless piece of paper that has the word “normal” circled several times, and then writing a canned message at the bottom. I’m glad that they no longer feel compelled to assume that all of their patients have only a grade school education and are afraid of numbers. I at least have a chance to understand where they’re coming from, and can spot test result trends right away.

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