Patients may not get word of abnormal test results
- Tuesday, June 23rd, 2009
By Anne Harding
NEW YORK (Reuters Health)
Casalino said he decided to conduct the study after a family member wasn't informed about abnormal test results. While the consequences were potentially serious, the researcher added, "things turned out OK." Nearly all of his study co-authors had experienced similar situations, he added.
To better understand how frequently such problems occur, Casalino and his team reviewed records for 5,434 randomly chosen patients 50 to 69 years old who were seen at 19 community and 4 academic practices. They identified 1,889 abnormal test results; in 135 of these cases, or 7.1%, the patient was not informed of the result.
They looked at 14 different tests, including cholesterol levels; hematocrit, which measures the proportion of blood volume taken up by red blood cells; potassium levels; and hemoglobin A1C, an indicator of long-term blood glucose level.
An abnormal result on any of the tests he and his colleagues looked at, Casalino noted, could signal serious illness; for example, colon cancers are often spotted when a patient has a low hematocrit level, indicating intestinal bleeding. Missing this sign could mean the difference between finding a cancer early, when it is curable, or later, when a cure may not be possible.
There were also sharp differences among practices in how frequently test results fell through the cracks; it never happened at three of the practices, but occurred more than 20% of the time at two of them. Practices that used a mix of electronic medical records and paper-based records had the highest rates of failing to inform patients of test results. None of the practices in the study had a consistent system for contacting patients when test results were abnormal.The findings should not be seen as "bashing physicians," said Casalino, who noted that it is a struggle for physicians and their office staff to keep track of a huge volume of medical tests and results. Also, he added, it's not a question of individual physicians doing a better job, but of a need to put systems in place that ensure abnormal test results are flagged and followed up appropriately.
While it's likely that nearly all medical records will be electronic 10 years from now, the researcher added, this in and of itself won't solve the problem. "We saw electronic medical records that clearly helped the practice in dealing with test results, we saw electronic medical records that clearly made it harder," he said.
For now, at least, the onus is on the patient. Anyone who has a medical test and doesn't hear back from their doctor's office within 2 weeks should call to check on the results, Casalino advised. "Mistakes get made, they really do. That's the only way to avoid potentially getting hurt."