Medical tests: Why ‘no news is good news’ can be dangerous


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12 comments

  1. Gerald Goldlist

    When I did blood tests and imaging in my practice, I always told patients that with me, no news meant there had been a breakdown in the communication chain. It could be at the testing institution, their report to me, my staff not getting it to me, my misfiling it, my getting the information back to my staff and my staff getting back to the patient. So there are lots of places for the chain to break. I told each patient that if they had not heard from my office by a specific time, which depended on the urgency of the situation, that they should call my office. Some doctors have patients make appointments to discuss the results to ensure that the patients’ results have not been lost in the shuffle. For someone like me, who only ordered a few tests per week, that was not too onerous. I feel for family physicians who must look so many test and imaging results and then communicate them to their patients.

    With the large demands on physician time and the busy lives of patients in 2016, this is a big problem. I hope that a workable and safe solution can be found.

  2. Trevor Jamieson

    Frankly, some of these issues don’t need multi-million dollar fixes and we often overthink the first steps.

    Step 1 – stop trying to call me or fax me with this stuff – please. I’m too busy to take calls, and faxing is inefficient (both for information transfer and trees) and faux-secure – I don’t walk around with a fax machine on my person, and I never will. I’m connected to email and texting all the time. Sure, all versions aren’t necessarily secure, but, I was using secure versions of both of these in the IT world in the early 2000s. Email, in particular, is a 30 year-old technology (in the public sphere – the first emails were actually sent back in the 70s) that we are still trying to formulate an opinion on in much of health. It’s kind of nuts.

    While security is batted around as a major issue, like I said, secure versions of peer to peer communication have existed forever, and don’t need to break the bank.

    The bigger issue is mentioned in the article: identity.

    While many physicians lack a secure electronic contact, those that do aren’t necessarily easier to contact. Many have multiple addresses (with restrictions on forwarding from one account to another) and many people have name reconciliation issues because they have the same name as someone else or because their contact name doesn’t match their professional name (nicknames, maiden names, etc). This is also not a difficult fix: index the electronic contact to a unique key – CPSO # seems natural for physicians – and allow people to have one primary clinical address that the others can be forwarded to (or even better – stop giving me different email addresses and allow me to have one @doctor.on.ca or @ontariomd or whatever is decided).

    That me emailing myself at another institution is potentially considered a privacy breach is asinine. Importantly, as more and more newer MDs spread their work across multiple practices, the exact same issue of sending things to the “right” fax machine exists – but we sweep that one under the rug and generally ignore it allowing people to have one and only one fax number for information – while if you suggest that I might get an email or secure text at one hospital for a patient I saw at another, suddenly the sky is falling.

    Another issue is raised and is very legit – coverage. When people are away, have locums, etc, you don’t want communication going into the ether. (Importantly, this is even worse for faxing as, whether away or not, I’m going to periodically get emails/texts and can direct the sender to the right person). Again, this doesn’t need to be a trillion dollar fix – a system that allows assigned coverage and message forwarding is not that novel. In health care we treat these things as if they are patentable revolutions.

    Start with the easy wins. The security already exists. The policies needs revamping.

  3. Peter G M Cox

    From experience as a caregiver for 15 years, I can attest to this being more than an occasional problem. As Trevor Jamieson points out, it shouldn’t require rocket science to resolve.

    Dave Price’s comments (at the end of the article) are indicative of a much greater barrier – one that impedes improvements in many aspects of healthcare, i.e. a consistent attitude of defensiveness and resistance to change. Matthew Syed, in his book “Black Box Thinking – The Surprising Truth About Success (and Why Some People Never Learn from their Mistakes)”, provides numerous insights into why this is so, not least that it is a natural human reaction not to admit to mistakes or omissions (even to ourselves). Applied at the organisational level it is, however, a formula for failure: again as Mr. Price indicates, we can only improve our own and organisations’ performance by recognizing errors and omissions, investigating systemic causes of them and devising solutions to prevent their re-occurrence. This approach to doing business in the air transportation industry has resulted in a truly staggering safety record.

    There are clearly “centres of excellence” in our healthcare system but all too often, even at the highest levels, “we” seem to do the exact opposite of this: the examples are legion but two of the most egregious are; the painfully frequent assertions that we have one of the best healthcare systems in the World when research done by the World Health Organisation, the OECD, the Commonwealth Fund and the Euro-Canada Health Consumer Index demonstrate that is patently untrue; and the attempts (by practically all provinces) to impede the CBC in producing the programme “Rate Your Hospital” a couple of years ago.

    Only the real commitment of senior management within the healthcare system can change the “culture” of “defensiveness and resistance” to one of transparency, disclosure and learning from errors and omissions. (Mathew Syed’s book would be a good place to start – since its publication he was engaged as an adviser to the UK National Health System.)

  4. Patricia Mirwaldt

    Interesting article. However, I don’t see how online portals that don’t send all results to patients will solve the issue of crucial results being ignored by docs. If they aren’t also shared with the patient there is no change in the likelihood that somethings will be lost to follow up. As well, life labs in BC shares results with patients only if they have a BCMSP number, about a third of my patients are from other provinces so they cannot use the eHealth service. Patient portals that originate from the practices EMR would be more reliable.

    • Trevor Jamieson (physician)

      Yes.

      Patient portals are contingent upon the patient/caregiver then having an efficient and relatively barrier free (I.e. Not being put on hold for 20 min or a Byzantine set of CYA verbiage and “press 1 for”, “press 2 for” only to be followed by being shunted somewhere else) method of communicating this back to the clinician and then communicating with the clinician about it – both of which are sorely lacking in general (although pockets of excellence exist). Without this, this is just a recipe for needless worry and unnecessary trips to urgent care and EDs.

      (the private industry trend – some telecoms, banks, etc – of telling approximate time to speak to the clinician followed by a call-back rather than waiting on hold would be a good, but insufficient, start.)

      I think bringing the patients into the picture is great, but access to the data is only part of the problem.

      Without the links back to the provider of continuity, the evitable result is the involvement of other providers based on availability and then unnecessary and/or redundant testing.

    • Judy Birdsell

      I wonder if the system in BC (and elsewhere) started by asking… how will the patient get all of their information in a timely fashion (regardless of province of origin) whether the decision would have been different? By extension, the patient hopefully could share that information with whatever provider was involved.

  5. Judy Birdsell

    The evidence for improved outcomes when patients are linked to one health are provider team (often called ‘medical homes’ is apparently clear. However, care and support that enables us as individuals and families to be healthy, stay healthy and achieve our ‘life goals’ is in reality a multifaceted set of relationships, services etc. If our ‘health support system’ is truly patient centred.. could we consider a ‘health home’ that is in fact, more virtual than ‘touchable’; our ‘medical home’ or family doctors office would be a critical part, but in this information age, would a ‘virtual ‘home base’ that includes all information and communication that is relevant to ‘me’ be collected in one place, including all the resources and contacts that I as an individual. If this ‘virtual health home’ was accessible to me and to any provider that I chose to give it to.. wouldn’t this enable continuity of care regardless of where I am. Of course in Canada, these ‘virtual health homes’ would need to be provincially based, but if I could access (and give access) from anywhere, I can see the benefits.

  6. Marg Wood

    I have just discovered that my blood tests show a very high colesterol and very high LDL. My colesterol levels have always been hig but my HDL was always higher than LDL. I have discovered there are many reasons that can cause this. I believe they made a mistake. I don’t eat red meat I eat a lot of foods and fish oil supplaments. I don’t eat sweets with a lot of sugar and very little salt and I rarely eat processed foods. I do take prescription pills for high blood pressure that could cause this and I refuse to take stattons. Why don’t doctors know that ssome drugs cause false high colesterol readings.

  7. Meredith

    Only testing to the lowest measure can also leave out a lot of information. The physician should have a responsibility to check the results and also retest if there is any doubt. Many persons healthy can normal falls slightly outside the measures of clinical norms. A doctor can know if there patient is becoming unwell by seeing whole results. For example someone with very low blood sugar historically then their sugar sits at the high range of normal, may be becoming critically ill. Simply looking if it fell in the laboratory’s marker for normal or not will not render a physician the full medical patterns and therefore treatment. Patients checking there own results is not always a good idea especially anyone with mental illness or limited medical skills may misinterpret or forget to check, ask someone else who is not authorized to check which goes again PHIPA, and also it certainly leaves the door open to hackers, and much misunderstanding about results even in someone who is highly educated.

  8. Holly

    If I cant see some test results does that mean something is wrong ?

  9. Kathleen

    My doctor ordered an urgent can scan, They said the results would be at docs that very day. I called the office and they said doc that ordered was off. I asked them if another doc could speak to me, they said Nope. Another day of worrying and missing work.

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