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Patients Often Not Told About Abnormal Test Results
Date:6/22/2009

Study finds communication breakdowns at least 7 percent of the time,,,,

MONDAY, June 22 (HealthDay News) -- People who visit their primary care physician for routine blood tests or screenings are often not informed of the results, a new study finds.

The failure of doctors and medical facilities to follow-up and give people test results is "relatively common," the researchers wrote, even when the results are abnormal and potentially troublesome, and affects one of every 14 tests.

"If you're a patient, it's often assumed that no news is good news," acknowledged Dr. Lawrence P. Casalino, an associate professor and chief of the division of outcomes and effectiveness research in the public health department at Weill Cornell Medical College in New York City and the study's lead author. "But the bottom line is that is not always the case, and patients should not passively go along with that."

Casalino and his colleagues report their findings in the June 22 issue of Archives of Internal Medicine.

The researchers reviewed the medical records of 5,434 people aged 50 to 69 years old. They focused on those who, in the previous year, had abnormal results on one of 11 blood tests or one of three screening tests at primary care facilities in the Midwest and on the West Coast. They also combed through responses to 176 surveys completed by physicians designed to assess test result management procedures at each facility.

The study found that in 135 cases -- of 1,889 abnormal test results -- either the person was not informed of the test results or the facility had not documented having communicated with the patient about the results. The upshot: more than a 7 percent failure rate in communicating abnormal test results.

Furthermore, the researchers found that most of the primary care facilities involved in the study did not follow basic protocol for test processing, and most did not have a defined policy on communicating test results to patients.

Though the study found no difference in failure rates between facilities that relied exclusively on paper records and those that used only electronic filings, medical practices that used a hybrid of paper and electronic record-keeping had the highest failure rates.

Practices that had in place better test result management procedures in general had lower failure rates, Casalino said.

"Yet even in the best doctor's office it is possible -- and, actually, not uncommon -- for test results one way or another to get overlooked," he said.

"A good relationship with your doctor is a valuable thing to have, but in this case it isn't enough," Casalino said. "You still need to be told whether your tests were normal or not. And if you don't get the result you're waiting for, you really should call the doctor's office and ask for it."

Diane Pinakiewicz, president of the nonprofit National Patient Safety Foundation, said that the test results issue falls into the broader context of patient safety concerns in "an imperfect system with any number of opportunities for things to go wrong or fall through the cracks."

Pinakiewicz said, "In the past -- 10 or 15 years ago -- if you didn't hear back about diagnostic test results, you probably simply assumed everything was OK. But the culture of medicine is changing," she added. "The patient of today is very different, and physicians and clinicians are also different. We know a lot more today about the safety importance of making sure physicians go through the entire continuum, from taking a sample to delivering results to patients. And physicians understand that transparency is important, and a patient's right to know is important."

Nonetheless, Pinakiewicz said, proactive patient vigilance is key to keeping track of personal medical information after doctor visits. That's particularly important, she noted, when changing care settings, from an in-hospital stay to outpatient treatment, for instance.

"Patients should not accept it when a physician or clinician says they will let you know if something is wrong," she said. "Patients should ask for their test results on a consistent basis, whether or not the results are of concern -- because, if you ask for them 100 percent of the time, there is no question you will always stay informed."

More information

The U.S. Department of Veterans Affairs has more on patient safety.



SOURCES: Lawrence P. Casalino, M.D., Ph.D., associate professor and chief, division of outcomes and effectiveness research, Department of Public Health, Weill Cornell Medical College, New York City; Diane Pinakiewicz, president, National Patient Safety Foundation, Boston; June 22, 2009, Archives of Internal Medicine


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