No News From Doctor Not Always Good News

Study: Patients Often Not Informed Of Abnormal Cancer Screenings And Other Test Results

(CBS/AP)  No news isn't necessarily good news for patients waiting for the results of medical tests. The first study of its kind finds doctors failed to inform patients of abnormal cancer screenings and other test results 1 out of 14 times.

The failure rate was higher at some doctors' offices, as high as 26 percent at one office. Few medical practices had explicit methods for how to tell patients, leaving each doctor to come up with a system. In some offices, patients were told if they didn't hear anything, they could assume their test results were normal.

David Tate, 46, didn't hear from his doctor about his routine lab tests. CBS News Medical Correspondent Dr. Jon LaPook reports that Tate's blood work indicated serious kidney disease. He wasn't told about it for two years, and ended up on dialysis.

"I was devestated," he tells Dr. LaPook.

"It really does happen all too often," said lead author Dr. Lawrence Casalino of Weill Cornell Medical College. The findings are published in Monday's Archives of Internal Medicine.

"If you've had a test, whether it be blood test or some kind of X-ray or ultrasound, don't assume because you haven't heard from your physician that the result is normal," Casalino said.

Practices with electronic medical records systems did worse or no better than those with paper systems in the study of more than 5,000 patients.

"If you have bad processes in place, electronic medical records are not going to solve your problems," said study co-author Dr. Daniel Dunham of Northwestern University's Feinberg School of Medicine.

Dr. Harvey Murff, a patient safety researcher at Vanderbilt University Medical Center who wasn't involved in the study, said the researchers gave doctors "the benefit of the doubt" and still found a significant problem.

The researchers chose tests findings in which any doctor would agree patients should be informed. And they gave doctors a chance to explain when they found nothing in medical charts showing patients had been notified of bad test results.

The tests included cholesterol blood work, mammograms, Pap smears and screening tests for colon cancer.

Failing to inform patients can lead to malpractice lawsuits and increased medical costs, the researchers said.

"If bad things happen to patients that could have been prevented, that will lead to higher costs and in some cases considerably higher costs," Casalino said.

Researchers reviewed the medical records of more than 5,000 randomly selected patients, ages 50 to 69, in 23 primary care practices in the Midwest and on the West coast. They excluded dying patients and others with severe medical conditions where informing a patient would be redundant.

They surveyed doctors about how their offices manage test results. The offices that followed certain processes - including asking patients to call if they don't hear any news - were less likely to have high failure rates.

The study was funded by the California HealthCare Foundation.

"Our goal is not to indict physicians," Dunham said. "It's about working smarter and getting processes in place."

[expresso2]

Everyone is eager to leave the blame at the doctor's doorstep. There are only 24 hours in a day. Doctors have a difficult time contacting patients about their lab results because they and their office staff are on the phone fighting with insurance companies trying to get insurance approval for a patient's medication or for a hospital admission or for a CT Scan or heaven forbid to get paid by the insurance company. Patients are also part if the problem. Most patient's never call back to find out what their results are. They expect the doctor's office to chase them down and inform them of the results. This becomes problematic since patients almost never keep their contact information current. The physician is usually the last to be informed when patients move to a new home or job or when their work, home or cell phone number changes. I wonder if Dr. Casalino and his colleagues considered this fact when analyzing their data.

[housedocus]

Logistically, it would be most efficient and make the most sense to send the results to the patient by email. Since routine email is not secure, however, it would be best to do it using an online email communications service such as www.housedoc.us, that is HIPAA compliant, open to all patients and their doctors, and free for routine office use. That way there is also a written record of the results, to minimize any errors.

[justcurious777]

What about people who have no computer? What would they do?

[YCantWeAllGetAlong]

Doctors whine about the cost of their malpractice insurance; rightly so in many cases. However, good follow up and communication is essential. I always get a sheet with my test results within a week. Never once in 25 years has my doctor failed to do this. He always does a yearly physical with an EKG (in the office), full blood work and a hands-on physical. I will hate the day that man retires, but for now, I refer my closest friends to him and they are amazed. A rare gem!

[erasmus111]

by ToolMangler1 June 22, 2009 7:35 PM PDT
I had a complete physical with EKG,Stress test, full blood workup. BMI was perfect, According to the Doctors I was in excellent health. One week later I died from a heart attack, It just so happened that I had gone to the emergancy room for sever 'heart burn'. and was on the table being examined when my heart just stopped. Surprise, surprise!!!


Well, it's a good thing they brought you back to life, otherwise I wouldn't have you to bug! : )

[ToolMangler1]

I had a complete physical with EKG,Stress test, full blood workup. BMI was perfect, According to the Doctors I was in excellent health. One week later I died from a heart attack, It just so happened that I had gone to the emergancy room for sever 'heart burn'. and was on the table being examined when my heart just stopped. Surprise, surprise!!!

[erasmus111]

by donnamae1 June 22, 2009 4:21 PM PDT
What is wrong with our system anymore.


You can't trust the doctors!! The insurance companies own them! They are looking out for their own best interests, not yours. The whole d*mn country is corrupt! I think that a lot of doctors have given up, because they can't do what is right. They can't do their jobs.

[credibility2]

If a patient goes in for a test and they haven't even asked their doctor how long it takes to get the results, and then if they don't hear anything during that time, then they should make a call to the hospital to inquire if results were sent to their doctor and when, and then another call to the doctor to find out what the results were. At some point patients have got to take control of their own destiny and stop expecting everything to be handed to them without expending some reasonable effort. If I get a diagnostic test and don't have results within a week, I start making the calls.

[donnamae1]

My husband was diagnosed with gall stones in June 2007, the Dr. said they wasn't going to take them out because they weren't bothering him. For a almost a year he kept going back and telling them he wasn't feeling good, they would run tests and they always came back abnormal up the right side. They still didn't do anything, finally in April 08 they did another test and it came back that he might have some cancer in his liver. They were going to start kemo but then decided to do the surgery after they put a port in. They done the surgery in July, 08 and had to take 3/4 of the liver, gall bladder & a small piece of the colon. They told me it had started in the gall bladder and spread throughout. He also got 3rd degree bed sores, then got infection from the port that they were suppose to take out and didn't. He passed away in Sept. 08. I saw the article on the man that had kidney trouble and it is a hard breaking thing when you trust the Dr. and he can't even tell you what's wrong. What is wrong with our system anymore. I couldn't even get noone to help me prove the wrongdoing on my husband. He would still be here today if only they would have listened to him.

[erasmus111]

The incompetence is mind boggling. Where does it end?

[debson1]

THis happened to me. i had a doppler study done per my doctors request and was told to call in two working days to get the results. I called but was told the doctor had not seen the results yet. I call everyday for a week and finally said "if there is anything wrong he will call me right?" They said yes but I never received a call so I assumed it was something I would just have to live with. 14 months later when I went back for a physcial, he seen the test result and said i needed surgery. I had clogged autries in both of my legs so bad that they had to do a bi-femoral bypass. Needless to say, I changed doctors and now I make sure I get results even if i have to go to the office and ask for the results.

[debson1]

THis happened to me. i had a doppler study done per my doctors request and was told to call in two working days to get the results. I called but was told the doctor had not seen the results yet. I call everyday for a week and finally said "if there is anything wrong he will call me right?" They said yes but I never received a call so I assumed it was something I would just have to live with. 14 months later when I went back for a physcial, he seen the test result and said i needed surgery. I had clogged autries in both of my legs so bad that they had to do a bi-femoral bypass. Needless to say, I changed doctors and now I make sure I get results even if i have to go to the office and ask for the results.

[Slrman]

Here in Brazil, when you get a medical test, there is an automatic second appointment to discuss the results. The doctor does not get paid for this visit, and the results are sent to the patient, not the doctor. They are clearly marked what the expected normal results should be and what your results are. You don't have to be a physician to understand if your results are good or bad. Yes, I know this makes too much sense for the USA. Besides, it removes the total air of omnipotence the doctors there like to maintain.