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.

Kevin 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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