What Your Doctor Isn’t Telling You Could Be Lethal

New research: Don’t assume your doctor’s office will call you if your test results are abnormal.

June 29, 2009

Paper records may be better for patients than some computer systems, a new study suggests.

RODALE NEWS, EMMAUS, PA—As it turns out, no news is not always good news. A new study shows that in one out of 14 abnormal test result cases, the patient was not informed of the irregular result. “You should not assume that no news is good news, even if the doctor’s office says, ‘If you don’t hear from us, it’s OK,’” says Lawrence Casalino, MD, chief of the division of outcomes and effectiveness research in the department of public health at Weill Cornell Medical College. “Even in the best-organized practice, things get lost,” he adds.

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THE DETAILS: Dr. Casalino, who himself has 20 years of family physician experience under his belt, knows firsthand how easy it is for test results to fall through the cracks. In his study, just published in the Archives of Internal Medicine, he analyzed 5,434 patient records from 23 physician practices across the country. While some of the practices were nearly perfect, others failed to let patients know of abnormal results 25 percent of the time. For some patients, that failure could be the difference between life and death.

Nor should you assume that your doctor’s fancy-schmancy computer system means the office is on top of things. Researchers found that groups that stuck with simple paper-based processes to manage test results were less likely to forget to inform patients of abnormal results. Electronic records didn’t necessarily prove more successful, and offices using a mix of paper and electronic records had even higher failure-to-inform rates.

To avoid errors, the study authors suggest all test results be routed to the proper physician, who then must sign off on the results. The office should contact patients with the test results no matter what the outcome, and then should document that the patient was called. As a backup, patients should be told to call within a certain time period if they haven’t heard from the doctor’s office.

WHAT IT MEANS: There’s a major shortage of primary care physicians in this country, and many are dealing with hundreds of test results a week, on top of financial and time-constraint pressures. Sometimes, labs flat-out send results to the wrong doctor. Other times, results are lost at the doctor’s office, or the doctor doesn’t call the patient after reviewing them. With some electronic records programs, the results could be sent directly to the patient’s file, and the doctor could forget to review them. “I’ve known doctors that have used Excel sheets trying to stay on top of what records to check for results,” Dr. Casalino says.

Here are some simple steps to stay on top of your medical records:

• Don’t wait more than two weeks. There are all types of ways labs and hospitals report test results to your general practitioner. Sometimes they’re faxed, sometimes just the urgent ones are faxed or phoned in. Other times they’re mailed. It depends on the lab and the result. With a mixed bag of reporting criteria, it’s not that hard to see how things fall through the cracks. Protect yourself by marking down the day of your test on the calendar, and then write a reminder to follow up. “Blood, Pap, mammogram, X ray, anything; call after two weeks have gone by and ask for the results,” says Dr. Casalino. Depending on what the doctor or nurse says, you may want to schedule a follow-up appointment.

• Be gently persistent. When the doctor orders a test for you, ask, “So you’ll let me know the results, doctor?” If they say no news is good news, smile and say, just to make sure, you’d like to be contacted either way. If you don’t hear back in two weeks, call the office.

• Don’t be impressed by electronic records. President Obama has been talking a lot about cutting healthcare costs by switching to electronic recordkeeping. But some programs are more successful than others. For instance, if the program automatically routes test results into a patient’s electronic record, it could fall through the cracks if the doctor doesn’t remember to go back and review it. Dr. Casalino says better electronic records programs require that test results go into a specific folder, and they stay there until the physician does something about it. “Records are getting better, and eventually all practices will probably have pretty good methods for dealing with test results,” Dr. Casalino says. “But you’d still want to practice to have good processes. Don’t tell patients no news is good news.”