Medical tests: don't forget to call for the results.

You go through the time, trouble, and expense of having a medical test. You don't call to learn the results, assuming all is well or the doctor would have called. In fact, some doctors never notify patients with serious abnormal test results, according to one of the rare studies on this topic. It found a 7% rate of either failure to inform patients of abnormal test results or failure to document in the medical record that the patients were informed. The study was led by Lawrence P. Casalino, MD, Weill Cornell Medical College, New York City, and published last month in the Archives of Internal Medicine.

Failure to inform a patient of abnormal outpatient medical tests is a serious medical error, say Casalino and colleagues. In fact, doctors would be expected to document the fact that they informed their patients in the medical record, given the fact that diagnostic errors are the most frequent cause of malpractice claims in the U.S.

The researchers reviewed the medical records of 5,434 randomly selected patients in 19 community-based primary care practices and four primary care practices affiliated with academic medical centers. Blood tests and three screening tests (mammography, Pap test, and fecal occult blood test for colon cancer) were selected as the focus of this study because they are commonly performed in the outpatient setting.

After singling out all the tests that had shown abnormal results, the researchers went through the medical records to find documentation that the patients were informed. Out of 1,889 abnormal test results, there were 135 apparent failures to inform. Additionally, the doctors were asked to respond to a six-question survey to determine whether they followed the standard steps that should be taken after a medical test, for example, the results go to the physician who ordered the test.

In all cases where there was no documentation, doctors were alerted to the fact and given the opportunity to either inform the patient or correct the record if, in fact, the patient had been informed. Some physicians said that their patients had been informed but did not document it; some had erroneously judged the test results to be insignificant; still others said they were not responsible for the test. The reviewers gave doctors the benefit of the doubt in the few cases that were ambiguous, allowing them to be counted as notified.

The researchers concluded that failure to inform patients of abnormal test results was "fairly common," occurring in one out of every 14 abnormal tests. The highest failure rate was shown in the practices that used a combination of paper and electronic medical records. There was no difference, however, between practices that relied solely on paper records and practices with complete electronic medical records, though the researchers added that few practices in their study had converted completely to electronic medical records.

Casalino and colleagues say their study is the first to look at a variety of medical tests and types of medical practices. It was funded by the California HealthCare Foundation.

Take-Home Message: Always call for your test results. Better yet, ask for a copy. To understand lab test results, go to Lab Tests Online, which bills itself as "a public resource for clinical lab testing from the clinical laboratory professionals who do the testing ... peer reviewed, non-commercial and patient centered" (http://www.labtestonline.org/understanding/index.html).

Maryann Napoli, Center for Medical Consumers [c] 2009

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