Booster Shots

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If the doctor doesn't call, don't assume those tests turned out fine

June 23, 2009 | 12:31 pm

“No news is good news” seems to be what most patients assume when they're waiting to hear about test results. But for 1 out of 14 of them, “no news” may in fact mean “bad news” that their doctor didn't inform them about, according to a study published in Archives of Internal Medicine on Monday.

The study, led by Dr. Lawrence Casalino of Weill Cornell Medical College, looked at more than 5,000 records of randomly selected middle-age patients from 23 primary care practices. 

The patients had received common blood and screening tests, including mammograms, pap smears,  cholesterol tests and red blood cell counts. “Abnormal results” that fell well outside the normal range  were reported in roughly one-third of patients. But in 7.1% of these cases, practices did not inform — or document that they had informed — patients.

Communication failures like this could have serious, even lethal, consequences, Casalino says.  “We weren’t looking for cholesterol levels that were trivially high,” he notes. Some patients weren't informed of total cholesterol levels as high as 318 mg/dL (above 200 mg/dL is considered high). If left untreated, such levels could eventually mean a stroke or a heart attack for some patients. 

Adds coauthor Dr. David Meltzer of the University of Chicago, seeing the numbers “would clearly require a doctor at the very least to have a discussion with the patient” — about lifestyle changes, medication or other forms of intervention.

You might think that switching to electronic medical records would be the solution -- but that's not necessarily so: Computerizing a process that is already being done poorly may yield even worse results, Casalino says. Good processes, using either electronic or paper-based methods, seem to be the key to fewer mistakes.

Casalino and colleagues propose common-sense procedures physicians could use to manage test results, including having the doctor sign off on all results and telling patients to call after a certain time interval if they have not been notified of their results.

Making a few simple changes to automate the system could reduce errors without necessarily making costs higher, Meltzer adds.  “A great example would be what happens in an airplane cockpit,” he says.  “There are certain pieces of information that are only considered transmitted if they are confirmed.  When a co-pilot says to the pilot, ‘We’re running out of fuel,’ the co-pilot’s job isn’t done until the pilot actually says ‘I heard you tell me that.’ ”

Until that happens, however, the study’s authors recommend that patients play an active role in their own care. The single most important message: Don’t assume no news is good news. Know which tests have been done, know when to expect them back -- and if you don’t hear anything, call. 

“It’s not hyperbole to say it could save your life,” Casalino says.

-- Shara Yurkiewicz