Physician Failure to Inform Patients of Abnormal Lab Tests All Too Common

I am quite familiar with the burden that is placed on patients regarding follow-up on lab studies. I finally have my personal physician trained, after many years of trying, to send me an email with my test results as well as his interpretation. It therefore came as no surprise when a recent article revealed that patients are frequently not informed about their test results, abnormal and otherwise (see: Physicians Frequently Fail to Inform Patients About Abnormal Test Results). Below is an excerpt from the article with boldface emphasis mine:

New research shows that physicians failed to report clinically significant abnormal test results to patients -- or to document that they had informed them -- in one out of every 14 cases of abnormal results. In some medical groups, the failure rate is close to zero; in others it is as high as one in four abnormal results. The analysis of 5,434 patient records from 23 physician practices across the country was led by Dr. Lawrence P. Casalino...and published today in the Archives of Internal Medicine. Dr. Casalino and his co-investigators revealed that groups using simple processes to manage test results had lower failures rates. Groups that did not consistently use these processes had both higher failure rates and physicians who were dissatisfied with their group's processes for managing test results. The study also found that having an electronic medical record did not reduce failure-to-inform rates -- and even increased them -- if the practice did not have good processes in place for managing test results....The study suggests that five simple, common-sense processes are useful for dealing with test results:

• All test results are routed to the responsible physician
• The physician signs off on all results
• The practice informs patients of all results, normal and abnormal, at least in general terms
• The practice documents that the patient has been informed
• Patients are told to call after a certain time interval if they have not been notified

[I]n many cases, physicians and their staff told patients that 'no news is good news' -- meaning they should assume that their tests are normal unless they are contacted. This is a dangerous assumption.

I really don't have much to add to this item -- the results and conclusions are quite clear. Physician practices need simple procedures for ensuring that patients are informed about all test results. There needs to be documentation embedded in office procedures that this patient communication step has been completed. As a double-check, patients should assume that their physician office procedures may be faulty and should take it as their personal responsibility to be aware of all lab test results. As noted above, an office EMR does not increase the chance that test results will be communicated to patients. Although this article is silent on the topic of personal health records, providing patient access to test results via a PHR could help to correct this communication problem. However, patient-accessible PHRs are not offered by most practices and this situation will probably not change much in the near future.