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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