Profession

Patients don't hear of abnormal results 7% of time

Study authors outline systemic changes for practices to improve communication.

By Kevin B. O’Reilly — Posted July 16, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Primary care doctors fail to inform patients of about one in 14 abnormal test results, according to a study of 5,434 medical records at 23 physician practices in the Midwest and on the West Coast.

Few practices have rules on how to manage test results and often leave the process to individual physicians, according to the study published in the June 22 Archives of Internal Medicine (link). Having electronic medical records was no guarantee of better test-results tracking.

Lawrence P. Casalino, MD, PhD, the study's lead author, said physician practices should be able to improve their performance on this basic measure of doctor-patient communication.

"For things that are susceptible to being dealt with in an organized systems approach, I think the failure rate can be very low," said Dr. Casalino, chief of the division of outcomes and effectiveness research in the Weill Cornell Medical College Dept. of Public Health in New York. "We may never get to zero, but we should get pretty close to zero."

Researchers gave physicians the benefit of the doubt when determining whether doctors informed their patients about abnormal test results. They included only test results that were "clinically significantly abnormal," and which an expert doctors' panel believed "nearly any physician would agree that the patient should be informed of the result."

The study authors also gave doctors credit even if they did not document informing the patient in the record. For example, if physicians changed a relevant medication after the test, repeated the test, ordered a related test or surgical procedure, then they were counted as having communicated the abnormal results to their patients.

Best practices

There are steps practices can take to make sure patients get word of abnormal test results, Dr. Casalino said. Clinics should ensure that:

  • All results are routed to the responsible physician.
  • The physician signs off on all results.
  • Patients are informed of all results, normal and abnormal. Clinics should steer clear of the "no news is good news" approach.
  • The patient test-result communication is documented.
  • Patients have been asked to check on their test results if they have not been notified within a given time frame.

Physician practices that best implemented these processes did not tell patients about abnormal test results 5.1% of the time. The clinics that did not enact these systemic changes fared nearly four times worse, failing to inform patients in about 20% of cases. Adherence to good processes was more important to success than having an electronic medical records system, the study found.

Dr. Casalino said the systems of care surrounding physicians must be excellent for doctors to offer the highest quality care.

"No matter how good a physician you are as an individual, if you are in practice in a group that doesn't systematically try to improve care and doesn't try to do the things to make the processes for dealing with things like test results better, then you are not a high-quality physician," Dr. Casalino said.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn