WebMD Medical News
Louise Chang, MD
June 22, 2009 -- Primary care clinicians and their staffs sometimes fail to inform all patients of the results of lab or screening tests -- or fail to keep records that patients were informed and thus have no proof, says a study in the June 22 issue of the Archives of Internal Medicine. That poses potential dangers to consumer health and possible legal troubles for doctors, researchers say.
"There is a disconnect in many offices, and this is alarming," Lawrence P. Casalino, MD, PhD, of Weill Cornell Medical College, tells WebMD. "Some patients aren't being told about the results of tests, and this shouldn't happen. The takeaway message for consumers is clear -- if you don't hear within two weeks, call your doctor's office."
Casalino, lead author of the study, and colleagues reviewed the medical records of 5,434 randomly selected patients between the ages of 50 and 69 in 23 primary care practices.
They identified 1,889 abnormal test results and 135 apparent failures to inform the patient or to document that the patient was informed. That’s a rate of 7.1%, or about one out of every 14 abnormal tests.
Practices that used a combination of paper and electronic records had the highest failure rates, the researchers say.
"Most [practices] did not have explicit rules for notifying patients of results, the researchers write. "To our knowledge, this is the first study to estimate the failure-to-inform rate across a variety of tests and types of medical practice." Casalino tells WebMD that "patients should never assume that no news is good news" because "a lot of things can go wrong in the office. Some may never receive a report from the lab, or it may come in but the doctor never sees it and it might get filed away before he does."
He tells WebMD that many primary care doctors' offices are swamped with paperwork, making it easy for test reports to go to the wrong place, or the right place and not be seen, and that often procedures are not in place to make sure doctors see and act on lab results.
"Doctors should at the least mail out a form and keep a copy in the charts," he says. "In our research team, it turned out that almost everybody had a personal experience with a missed communication."
Co-author Daniel Dunham, MD, of the Northwestern University Feinberg School of Medicine, says switching to electronic records systems won't solve the problem.
"An electronic record is a tool that can help improve or facilitate communication, but you need processes in place to deal with labs," he tells WebMD. "And, many things can go wrong. It could be the doctor had the wrong phone number, or the wrong address. To this day, we tell patients the responsibility is on us to communicate with them."
But the backup for patients should always be to call their doctors if they aren't notified of the results of tests, Dunham says.
Atlanta internist Sandra Fryhofer, MD, past president of the 120,000-member American College of Physicians, tells WebMD that "the results of this study are quite concerning. This is a systems problem that must be resolved." It's too easy for "something to fall through the cracks," she says. "Patients need to ask their doctor the procedure for finding out test results. They also need to ask how long it will take results to come back."
The study authors write that diagnostic errors are the most frequent cause of malpractice claims in the U.S., and that testing-related mistakes can lead to serious problems.
"There are many steps in the testing process, which extends from ordering a test to providing appropriate follow-up," the authors write. "An error in any one of these steps can have lethal consequences."
Art Hopkins, MD, an internist at Montefiore Medical Center in New York, says he doubts miscommunications are as common as the study suggests, but such incidents are bound to happen because internists are so busy.
"The biggest mistake we see when we see these things not dealt with is when the doctor knows the patient has an appointment in a month and plans to deal with it then, and then the patient doesn't show up," Hopkins tells WebMD.
And in many cases, doctors may choose not to call patients "because we know that they know we know what's going on, and they trust us, so we don’t call unless it's necessary," he says. "We have found when we call patients about lab results, they give us better patient satisfaction scores. But we don't want to call with information that could confuse them, give them more information than they need for some minor change. You can create anxiety. If the result is expected or not relevant, we don't call."
Fryhofer agrees that patients must trust their doctors, but tells WebMD she's "glad they did a study like this that uncovers this problem. It's a wake-up call to doctors and patients."
SOURCES:News release, Weill Cornell Medical College, New York.Casalino, L. Archives of Internal Medicine, June 22, 2009; vol 169.Lawrence Casalino, MD, Weill Cornell Medical College.Daniel Dunham, MD, Northwestern University Feinberg School of Medicine.Sandra Fryhofer, MD, Atlanta internist; past president of the American College of Physicians.Art Hopkins, MD, Montefiore Medical Center.
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