Thursday, November 17, 2005
Following up on test results is important

By Dr. Anthony Policastro
Nanticoke Memorial Hospital

I am on the State Board of Medical Practice. The board receives a variety of complaints. Some of those are related to abnormal lab and X-ray results that are not told to the patient. Every physician's office does multiple lab and X-ray tests. Most of those are normal. This creates several problems. The first problem is keeping a record of who has had tests ordered. Because of the large number of tests, this would involve an extensive record keeping system. The record keeping system would require a list of the patient's name, the date of the test, the result of the test, and information that the patient had been called with the result. This method ensures that the office knows about the result. It ensures that such knowledge is documented. It insures that the patient hears about the result. It insures that the call to the patient is documented. It also takes an enormous amount of time. The time is needed not only to make the calls to patients but also to keep the tracking record up to date. This method lets the patients know all their results. It also lets the office know that it has received all test results. This method is difficult in a busy office practice. For that reason, the most common method is for the physician's office to wait until tests are returned. At that point, the patient is called and given the result. The physician then documents the date and time of the call. The result is then filed in the patient's record. This method ensures that the patient finds out about results the office receives. It ensures that the call to the patient is documented. This method takes less time.

However, phone calls take a lot of time. The more calls you do, the more time it takes. Results cannot be left on answering machines. They cannot be left with family members. That is why calling all normal lab results is such a problem. This method gets results to the patient. However, it does not guarantee that all results return to the office. Other offices will only call patients about abnormal results. This is the most efficient method. It saves the office staff time on the phone trying to track down patients just to tell them about normal results. This last method ensures that the patient receives abnormal lab results that arrive at the office. However, it does not close the loop to patients with normal lab results. It also does not guarantee that all results return to the office. The weakness in the last two methods is related to the fact that not all results make it back to the office. If a normal result does not make it back and the patient is not called, care may or may not be impacted in a negative fashion. However, if an abnormal result does not come back, it frequently could cause a variety of problems. For that reason, it means the patient must play an active role. The patient should know what tests have been ordered and have a feel as to how long it would take to get the results back. If the patient does not hear about the results in a reasonable period of time, he/she should call the office to inquire. Patient involvement in their care is important in many ways. In the past I have addressed the need to tell physicians about all drugs that you take even if they are over the counter or herbal remedies. In the past I have addressed the need to ask about medications that are prescribed. This is just another aspect of patient care that all patients should be ready to address with their physician. It is far easier to make a call to the office to check on a result than it is to investigate at the state level months later what happened to the result.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.