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Source: MedPage Today

Patients Freqently Not Given Important Test Results

With ever more expensive and elaborate diagnostic tests acting as a major driver of the $2.4 trillion annual cost of our nation’s sick care industry, it is very alarming news that abnormal test results are not communicated to patients more than 6% of the time, according to researchers in a multicenter study reported in the June 22 issue of Archives of Internal Medicine.

The researchers analyzed records of 23 separate primary care medical practices and a total of 1,889 abnormal test results. When the records did not indicate that a result had been communicated to patients, the researchers contacted the physician to ask what happened.

For 117 of the abnormal results (6.2%), Dr. Casalino and colleagues found that the patient was never informed.

In another 18 cases (0.9%), the physician said the patient had been informed, but it had not been documented.

"Some elements of medical care (e.g., diagnosis) are an art as well as a science, depend heavily on the cognitive skills and effort of individual physicians, involve much uncertainty, and will probably always have relatively high error rates," the researchers wrote. "However, notifying patients of test results does not appear to be such a process; with appropriate within-practice systems, low rates of failure to inform should be possible."

In addition to examining follow-through on individual abnormal test results, Dr. Casalino and colleagues also surveyed physicians in each participating practice about their processes for communicating all test results.

"Very few practices had explicit rules for managing test results," the researchers found. In most cases, each physician had his or her own method.

Physicians in eight practices said their policy was "no news is good news" -- that is, patients were told that if they heard nothing about a test result, they could assume it was normal.

Dr. Casalino and colleagues called that policy "dangerous" and noted that the Agency for Healthcare Research and Quality advises patients never to assume such a thing.