September 2008

Test Anxiety

Have you ever spent the weekend awaiting results of a medical test -- to confirm a cancer diagnosis, for example -- after the doctor failed to call Thursday as promised and didn’t return your calls on Friday? Gives new meaning to the idea of “the endless weekend.”

When I ask people about their health care, one topic that comes up repeatedly is when and how they receive the results of medical tests. The situation described above is too common. But so are lost results, dangerous conditions that were detected but never reported to patients and general bewilderment about what the test results actually mean.

A fiery argument about patient notification of medical test results recently raged on the New York Times “Well” blog. Most doctors discussed the logistical difficulties of keeping track of and communicating with all their patients about all their test results. Some doctors and some patients took the middle ground – “If you don’t hear from the doctor, call and inquire.” Outraged patients’ responses ranged from “I don’t know what these results mean – the doctor should call me to explain” to stories of recalcitrant providers whose non-responsiveness resulted in the patient firing his doctor or injury or both.

The number of tests results successfully reported to patients undoubtedly dwarfs the frequency of erroneous, misplaced or unread findings. But this whole business of learning test results illustrates our larger struggle to find the right balance of responsibility with those who care for us.

Being a passive patient is no longer an option. But the transition to more active participation in our care means that we need guidance about how to play our new role effectively.

How are we supposed to know the process a specific doctor or clinic uses to report results to patients unless we are told? How can we tell if it has happened and what we should do if it doesn’t? Guess?

I would welcome a piece of paper that says the following:

“This is how we handle tests here:

• We expect to receive the results within 5 days.
• We will notify you within 3 days of their receipt by (select one)
  • a) e-mail
  • b) telephone – direct contact
  • c) telephone voicemail

We will give you information about whether and how to follow up with the doctor at this time.

• We will send you a copy of the test report within a week of receipt of the results including a brief explanation of the purpose of the test and the meaning of the results.
• If you have questions, need to expedite this process or if you do not hear from us by X date, please call Patricia at this number.”

While this piece of paper won’t ensure accurate testing, competent interpretation or a clear course of action based on my test results, it does tell me some of the steps I need to take to be a competent participant in my own care.

This is a small piece of health care delivery but it illustrates a critical point. Knowing (1) what is supposed to happen, (2) who is accountable for it and (3) what our responsibility is in ensuring that it happens is a basic requirement for each of us if we are to benefit from the health care that is available to us.

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Resource: New York Times, Well Blog: http://well.blogs.nytimes.com/2008/08/21/why-you-should-call-your-doctor-for-test-results/

The Zigzag Path to Truth - Apr. 2002