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John Whyte, M.D., MPH Headshot

'The Doctor Will Call You if Anything Is Wrong'

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That's still a common phrase you might from the doctor after you've have some lab test, biopsy or imaging study like a CT scan. Sometimes the doctor will say "If you don't hear from me, everything is fine." Well, given the complexity and comprehensiveness of medical exams nowadays, that's probably not a good idea. And honestly, it's never been a good idea to assume no news is good news.

Nearly every physician knows some instance where he/she or a colleague missed an important lab result. Either the report never came to them, or it was misfiled, or they simply didn't notice the abnormal result. In fact, it happens nearly 8 percent of the time. There used to be a phrase when I was training -- "WNL" -- it's supposed to mean "within normal limits" for a lab result but at times it also meant "we never looked" when the workload was simply overwhelming.

The development of electronic health records has helped in notifying physicians of abnormal lab results or a suspicious imaging result on a CT scan or chest X-ray, but some results can still be overlooked. And when we don't tell patients anything about their lab results, they assume everything is normal.

I often have friends as well as family members talk to me about their health conditions. Every physician does -- I guess that's a benefit of having a physician in the family or as a friend. When posed with health questions, I'll frequently ask my family and friends if their blood sugar is high or if their cholesterol is normal. Many times, they'll say "it's fine." When I ask the specific number or probe further, they'll admit their lack of knowledge and say "the doctor would have told me if the results were too high." Worse, I'll ask if they know for sure if the doctor ordered a specific lab test, and the response will be "I'm sure he did," when in fact they don't know.

That's why I'm a big supporter of patients having direct access to lab results. There has been much discussion about access to one's entire medical record, and I definitely support that as well. But patients should also be able to have lab results sent directly to them. Believe it or not, you currently don't have that right in most states. It might change, however, with new regulations proposed by the U.S. Department of Health and Human Services. This draft new rule would allow patients to get their lab results directly from the lab rather than having to get their results from the doctor's office. It makes sense, doesn't it? After all, they're your results! I believe this ability empowers patients to be more involved in their own health care. Not all patients will want their lab results but if you do, you should be able to have access to them on your own terms. "Knowledge is power" and by having a copy of their lab results, patients can become more empowered in getting better care.

As you can imagine, people don't like to give up power, and I'm a bit disappointed in the American Medical Association as well as the major lab groups and some hospitals. They are upset because the rule would not require physicians to get the lab results before the patients. The proposed rule also doesn't distinguish types of tests -- all would be immediately available to patients, whether it's a blood sugar or a HIV test. These groups argue that consumers might become unduly concerned about minor lab results abnormalities or have trouble understanding the reports without the support of a doctor. They argue that this may create undue anxiety for patients. At the same time, I've know many people who are quite anxious waiting for the lab results from the doctor's office, and often it's the nursing staff that communicates abnormal lab results -- not always the physician. Let's be honest -- the doctor's office isn't the most customer-service oriented place we go.

I do understand my fellow physicians' perspective but I think there is a much greater risk of having an important abnormal lab result missed than too much concern about who gets the information first. When patients receive their own lab results, it actually can strengthen the physician patient relationship by creating more dialogue. We should all support unfettered access to information that impacts our health, and thus our lives... don't you think?

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