Test results without physician guidance will cause patient anxiety

The following column was published on August 5th, 2012 in USA Today.

A patient once blamed me for causing him considerable anxiety because he had to wait several weeks before receiving the results of a lab test, which I had ordered. Many patients commonly have to wait days, if not weeks, before getting lab results from their doctor. The delay can affect patients’ health negatively.

For instance, one study looked at women who underwent a breast biopsy for possible cancer. It took one to six days for these patients to obtain their results. Those who had to wait longer had abnormal biochemical stress levels, which can potentially affect their healing times from the biopsy.

The U.S. Department of Health and Human Services wants to change the lab results system. HHS proposals would allow patients to immediately review their lab results via a website, almost at the same time as their physicians. Whether this is a good idea or bad will depend on what happens after the patients view their results.

Patients deserve access

Patients should have access to their lab tests. But it is crucial that a medical professional explains the results. Raw numbers without the benefit of context can also cause patient anxiety. Some abnormal results are due to chance or lab errors. Other results can be a normal variation for that individual patient. Many lab results are misleading and not indicative of any disease. Patients often assume the worst, so viewing results alone might cause unnecessary alarm.

An unintended consequence of this approach could be that anxious patients flood doctors’ offices with telephone calls. Or they might go to the Internet for a general interpretation, which isn’t geared to a patient’s individual condition. A website could also provide the wrong information, which is sometimes based on opinion.

Patients already have access to some test results without involving a doctor. Direct-to-consumer genetic tests can tell patients whether they are at risk for conditions such as Alzheimer’s disease or diabetes. At-home HIV testing was recently approved by the Food and Drug Administration.

Tests are not foolproof

Remember that just because a genetic test shows a low risk of diabetes, it doesn’t mean a patient should stop leading a healthy lifestyle. Likewise, the at-home HIV test isn’t foolproof. On average, if 100 consumers with HIV took the test, 92 would receive the correct, positive result, while eight would receive an incorrect result.

Without professional post-test guidance, these results can have significant misleading repercussions. Patients feel empowered by the wealth of instantly available data. However, more still needs to be done to provide the guidance. Electronic medical records can help doctors more efficiently interpret tests and send a letter with their recommendations in a matter of keystrokes. Unfortunately, only 51% of physician practices use digital records.

Before performing any test, doctors should manage patient expectations. Doctors should tell patients what the tests results could indicate and how the results might affect their treatment. The conversation should end with a clear plan of how and when the patient will be informed of the test result.

Direct and instant lab results are changing the relationship between doctors and patients, who increasingly have access to a wealth of data. Seeing test results might relieve patients of the anxiety of waiting. Without appropriate interpretation and guidance, however, that anxiety could be replaced with the worry of wondering what they truly mean.

Test results without physician guidance will cause patient anxietyKevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://cognovant.com/ W Joseph Ketcherside, MD

    Might result in, could be, should, can have – anything here other than the author’s desire to keep EVERYONE waiting and anxious so that a couple nervous nelliies don’t get upset when they see a result without the doctor’s calming hand? Come on, most of the time the nurse gives the patient the results anyway – and it’s rare that there is actual “counseling”. And how many times does the office fail to contact the patient at all? I know personally of adverse outcomes suffered by patients when they did not get lab results in a timely manner. But I have not yet heard of a patient who suffered an adverse event because they found out their lab result before the doctor told them.

    So I put forth the same challenge here that I have in other forums. Either provide me with evidence of a patient who was directly harmed by finding out their lab results before the doctor called them, or stop putting your paternalistic opinions in the way of me getting my own medical data when it is done, and taking responsibility for my own health.

    Evidence-based medicine. Don’t reply with an opinion. Cite it, or zip it.

  • EmilyAnon

    It’s not uncommon to hear from the doctor’s staff after a test: “if you don’t hear from us, everything’s OK”. Is that just being efficient, lazy or reckless?

  • http://www.facebook.com/people/Joel-Selmeier/686242826 Joel Selmeier

    There have been two studies examining what happens when
    patients receive the results of DNA tests without the intervention of physicians. Both found the group-think of the medical profession’s speculations on this to be wrong.

    One followed more than 2000 people who had genomewide
    scans and were given estimates of their genetic risk for more than 20 different
    conditions. About six months after receiving the 90-page reports explaining their
    genetic risks, the level of psychological anxiety had not risen among the
    patients. They were not overwhelmed by the information and had not engaged in rash
    behavior as a result of it.

    Yet physicians persuaded the state of New York to pass a
    law requiring patients to go through physicians for these tests because of the
    speculations you raised. The world created for patients
    depends too much on the speculations of physicians. This is why patients need
    advocates who are on their side representing their interests. Physicians think that they are, but they deny patients knowledge about their own bodies because of speculations?

    I consider it a basic human right to be allowed to learn
    about your own body. Since when is denying someone a basic right justified by speculations
    about inconvenient phone calls and anxiety?

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