Bad test results often don’t reach patients
Study: Doctors fail to inform patients of abnormal findings 1 in 14 times
updated 6:18 p.m. CT, Mon., June 22, 2009
CHICAGO - 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.
"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.
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"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.
Ask about test results
Patients should ask their doctors how they plan to tell them about the results of medical tests, experts say, and never assume "no news is good news."
Here are questions patients can ask at the doctor's office:
— Does this office send all test results to the doctor who's responsible for my care?
— Will my doctor see and sign off on all my test results?
— Will someone inform me of all my results, both normal and abnormal?
— Will it be documented in my chart that I've been informed?
— Is it OK for me to call after a certain time if I don't hear anything about my test results?
Source: Archives of Internal Medicine, AP interviews
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."