When getting bad medical test results, it can be easier to hear them from a primary care physician or some other medical professional with whom you already have an established relationship. It is very common practice for testing physicians (such as lab technicians and radiologists) to communicate test results to treating doctors, who then pass the info on to patients.
But as it turns out, this practice commonly leads to communication errors with patients, missed diagnoses or delayed diagnoses. If given the choice, most of us would prefer getting accurate results from someone we didn’t know to getting inaccurate results from our own doctor (or missing results altogether).
This was the subject of a recent op-ed by a Yale School of Medicine professor of pathology. She describes herself as a pathologist “who deals specifically with discovering ways to avoid diagnostic error,” and she believes that many of these errors could be avoided if testing physicians simply communicated directly with patients rather than using the treating physician as an intermediary.
Here are two common reasons why this communication chain can lead to errors or missed information:
Medicine is getting more specialized: There are a wide variety of tests and images that are utilized these days, and treating physicians typically cannot be as knowledgeable or proficient with test results as the doctors who actually conducted the tests. They may look at results on paper but misinterpret data or overlook important details.
Patients don’t always see the same doctors: If you go the emergency room, you’ll be treated by whichever doctor can see you first. You likely will have no idea who this doctor is. He may order test results that will be returned to him, by which point you may already have gone home. If you come into the ER a couple days later, you may have a different doctor who doesn’t know that you are waiting on test results. There are no guarantees that anyone will contact you about results after you leave.
The article’s author strongly advocates instituting the practice of direct reporting between testing physicians and patients. In cases where it would make sense to do so, treating physicians can also be present for the conversation. This is the easiest and most direct way to ensure that information makes it to the patient and is delivered/interpreted correctly.
Pennsylvania is slightly further along in this goal than other states after passing “The Patient Test Result Information Act.” It mandates that imaging centers inform patients within 20 days if there are “significant findings” in test results. But this bill doesn’t do enough to tackle the problem, and it exempts emergency room imaging altogether.
Until or unless commonsense protocols like direct reporting are widely adopted, we can be sure that missed and delayed diagnoses will continue to be major problems for patients.