Patients Often Left Uninformed of Medical Test Results

Never before have doctors had so many medical tests at their disposal—tests to screen for disease, to diagnose disease, to classify and measure the severity of a disease that has already been diagnosed, to confirm that a person is free from disease, or to plan the treatment for a disease or condition—and these tests drive a large part of the clinical decisions made about our health. Simple tests performed in a doctor’s office often have immediate results, whereas other tests that require a laboratory may take days or even weeks. But given the crucial role test results play in medical decision-making, the patient is notified soon after the doctor receives and reviews the findings, especially if there is a problem, aren’t they?

In far too many instances—the answer is NO. A recent analysis of 5,434 patient records from 23 primary care practices in the Midwest and on the West Coast revealed that doctors either failed to report abnormal tests or document that the patient had been informed of the results 7.1 percent of the time, or about one out of every 14 tests. However, performance at individual practices varied; some consistently informed patients and some failed to inform patients as much as 26 percent of the time. The tests included mammograms, Pap smears, cholesterol blood work, and screening tests for diabetes and colon cancer.

“It really does happen all too often,” said lead author Dr. Lawrence Casalino, chief of the Division of Outcomes and Effectiveness Research in the Department of Public Health of Weill Cornell Medical College. “Even in the best doctor’s office it is possible—and, actually, not uncommon—for test results one way or another to get overlooked.”

The researchers found no significant difference in failure rates between facilities that relied exclusively on paper records and those that used only electronic filings. However, the practices that used a combination of paper and electronic record-keeping had the highest failure rates. “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.
 
Furthermore, the researchers found that most facilities did not follow basic protocol for test processing, and most did not have an explicit policy on communicating test results to patients. Many offices simply told patients that if they didn’t hear anything, they could assume their test results were normal. “If you’re a patient, it’s often assumed that no news is good news,” Casalino said. “But the bottom line is that is not always the case, and patients should not passively go along with that.”

Failing to inform patients about abnormal test results can lead to a delay in the treatment of serious conditions, possibly decreasing the patient’s chances of survival, and exposing doctors to costly legal action. “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. “Failure to diagnose is one of the most common causes of malpractice suits.”

Casalino said it’s imperative that doctors have explicit rules for informing patients of test results. “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. “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.”
 
The authors concluded that following five relatively simple, common-sense procedures could eliminate most errors: (1) all test results are routed to the responsible doctor; (2) the doctor signs off on all results; (3) the office informs patients of all results, normal and abnormal; (4) the office documents that the patient has been informed; and last by not least, (5) patients are told to call after a certain time interval if they have not been notified.