Waiting is part of life. But should it be a mandatory part of routine medical care? Recently an article was published in the New York Times
by Jan Hoffman that examined the anxiety and emotional angst associated with waiting for test results. Often, patients and families are made to wait for days if not weeks to receive a call from the physician or nurse relaying their test results. The current system is inefficient and fraught with problems. In our digital age of real time tweets and facebook posts, why is it so darn difficult to get data from tests to our patients quickly?A lot of the problem goes back to the earlier, more paternal days of medicine when a doctor was expected to manage care and do what was in the best interest of the patient. Involvement of patients in decision making was much less common. Often test results were provided to patients on a “need to know” basis. Certainly, I expect the motivation for this early practice was to avoid unnecessary worry and to provide the best possible care. However, today’s medicine is practiced much differently. As providers, we should welcome and emphasize patient engagement and participation in care. Clearly, outcomes are improved when patients actively manage their own disease in cooperation with their physician. In addition, patients and providers are very well informed and have access to instantaneous information from the internet. In the past, it was deemed necessary for test results to be delivered and interpreted by a physician or designate in order to properly explain and help the patient process and understand the result. Today, that is still partly true. However, when ordering a battery of tests, clinicians must spend time discussing the reason for the testing and the possible or expected results with the patient and family. These discussions will help prepare the patient for various test outcome scenarios. Although, anxiety may still remain, the patient will have some time to prepare emotionally for the possibilities. As with most of medicine, communication between patient and physician typically lessens anxiety, improves understanding and forges better healthcare partnerships.
In this new era of digital medicine, I believe that our system of delivering test results to patients is antiquated. Although meeting or speaking with a physician or other healthcare provider to help interpret test results remains necessary, I believe that patients should have “real-time” access to the results–their own healthcare data. Internet based “patient portals” that are secure and HIPAA compliant are a must. Going forward, our patients that have labs, Xrays, CT scans or other studies performed should be able to view results as they are posted by the interpreting physician. Certainly, all patients are not going to be able to fully understand and interpret the results as dictated in a report, but at least they will not remain in purgatory waiting to hear. If the test reveals a particularly troubling result, the responsible physician must reach out to that particular patient and family in a timely fashion. Follow up office discussions of results remain a cornerstone of high quality care even when data is made immediately available.
In the Times article, a family waited nearly a week for lab results to be reported and discussed. During that time, the patient feared the worst. After waiting days on end and having countless sleepless nights, she was eventually informed that the only abnormality was relatively trivial. The delay in communication resulted in unnecessary worry by both the patient and family. Remember, we want our patients to be engaged in their own healthcare. They trust their provider to shepherd them through the maze of diagnostic testing that the medicine often requires. Education and understanding is paramount. When ordering diagnostic testing, make sure that the patient understands why the test was ordered and what you are looking for. Make sure you set reasonable expectations as to when the results will be made available. As I have said in previous blogs, data is empowering. We must advocate for our patients. We must reduce patient anxiety and do a better job of providing them with timely access to their healthcare data.