United Press International - October 11, 2005
Alex Cukan, UPI Health Correspondent

"Actually, no news may mean something has fallen through the cracks -- test results are often given by mail, but if the result is unexpected, we usually attempt to call the patient," Dr. Thomas Payne, clinical associate professor at the University of Washington School of Medicine in Seattle, told UPI's Caregiving.

"In some cases such as HIV test results we tell patients at the time of testing that we will give them results in a subsequent clinic visit but not over the phone. But in my experience, almost everyone prefers to hear about their test results unless they are very routine, repetitive tests."

But even getting routine laboratory tests can be a trial for some because different doctors deal with this issue differently.

In 1992 my father had a heart attack and he needed to take the blood thinner Coumadin, which requires a periodic blood test. At that time, my father was seeing his cardiologist every six weeks and the doctor took the blood in his office. After each visit the cardiologist would call me with the results -- anywhere from two hours after the visit to 48 hours afterwards.

I remember it as a tense time, where I would immediately go home and stay put and refuse to talk to anyone else on the telephone -- this was before call waiting -- so I would not miss his call. The cardiologist was the last person I wanted to play phone tag with.

After doing this every six week for several years, the cardiologist changed his method -- to the best system I've encountered. The cardiologist would send a handwritten memo with the results of the blood clotting times as well as cholesterol, triglycerides and blood sugar. It was a great way of providing feedback, and I no longer had to be on "red alert" after a doctor's visit.

When the cardiologist retired, alas, his secretary told me, "Don't expect any other cardiologist to send the written test results." She was right.

"There is no standard for reporting test results -- a couple of studies prefer the patient to be notified one way or the other. In my own practice, I say, 'If you don't hear from me assume everything is OK,'" said Dr. Anna B. Reisman, who sees patients in the VA primary care clinic and women's center in New Haven, Conn. "But if it falls through the cracks it is my fault. It's not ideal."

Some doctors use e-mail for routine test results, but others shy away from it because of security issues -- many advise not to write any information in e-mail you wouldn't want written on a postcard. However, e-mail messages can be encrypted, according to Reisman.

Some doctors use an automated system: The patient calls a number and via an extension the doctor leaves a voice message giving the test results. One patient told me she favors this system because she can call the number at her convenience and repeat the message if necessary.

Some doctors have the patient call the office, and the nurse relays the test results. But that's something Dr. Nathan Vermedahl, chief resident at North Colorado Medical Center in Greeley, says he never does.

"It only takes a half-hour a day to call everyone and give them their test results, and quite frankly our patients expect it," he told Caregiving.

Some patients would prefer not to get medical information while at work -- even routine tests. But many doctors say calling patients at work might be the only time they can reach them.

My mother worked at a bank about 50 years ago, while she was pregnant. The obstetrician's nurse would call her at the bank. The nurse would ask several questions but all were formed so my mother only had to say "yes" or "no."

"Some screening follow-up can be notoriously bad -- the follow-up on something as simple as a stool test for colon cancer is not what it should be," Catherine Dube, who teaches clinical interviewing skills to medical students at Brown University Medical School, told Caregiving.

"These tests are handed out a lot, but the doctor never really knows if the patient has returned it to the lab unless they look for the result the next time the patient is in."

Reisman suggests that if a doctor needs to speak with a patient while at work, the physician should ask, "Are you free to talk?" Dube suggests discussing and arranging how test results will be given -- before the tests are taken.

Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column. E-mail: sciencemail@upi.com

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