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Test results: whose job is it to tell the patient?


The Personal Health Navigator is available to all Canadian patients. Questions about your doctor, hospital or how to navigate the health care system can be sent to AskLisa@Sunnybrook.ca

The Question: Is it the family physician’s job to gather test results and explain the outcome of those tests – blood tests, ultrasounds, X-rays and CT scans – and offer options going forward? Every test I have had, the results are sent to my family doctor, yet he says it is not his job to explain it to me and offer solutions or options. Half of the tests are missing or have not arrived at his office. There is no follow up. Every time I see him it is like the first time but he has been my primary caregiver for 25 years.

The Answer: You raise a very good question: Whose job is it to communicate test results ordered by one physician and conducted by another? If, as you point out, the test results go missing, you have no way of knowing and may assume [wrongly] that there was a negative finding and all was well. It is for that reason, it is important to ensure that the loop has been closed on every test result.
According to Jocelyn Charles, Chief of Family and Community Medicine at Sunnybrook, a physician who orders a test – for blood, ultrasound, X-rays or CT scans – is responsible for responding to abnormal results and communicating these results to the patient.

“Specialists are expected to communicate their assessments, test results and recommendations to the patient and the patient’s family physician,” wrote Dr. Charles in an email. “The family physician can only discuss results from specialists if they are forwarded to him/her, ideally with a recommendation about any further investigations or treatment.”

Ultimately, it is the responsibility of hospitals, laboratories, radiology facilities and specialists to ensure that family physicians receive results and information pertaining to their patients in a timely manner, she said.

As the family physician has no way of knowing what tests were done by the specialist unless this was communicated to them, Dr. Charles suggested patients call their family physician before their appointment to ensure test results have been received.

In addition, patients can request the specialist’s office, hospital or laboratory to forward the results to their family physician prior to their appointment. Ideally, this should not be necessary, points out Dr. Charles, who said efforts are underway at her hospital to improve accountability for timely communication of information to family physicians.

Frank Martino, president of the Ontario College of Family Physicians, suggested patients remind the specialists that test results should be sent to the family doctor, providing the address if necessary right at the appointment time.

He pointed out that it is incumbent on him, as a family physician, to learn the results of any test he has ordered on a patient.

“I have concerns about this patient’s problem not getting the results,” said Dr. Martino. “And a physician who says it’s not my job to explain things to you. That’s part of the relationship.”

However, not every negative result – a test that has normal findings – needs to be communicated. There are, however, exceptions to that rule: the test ordered was due to a screening test, a suspected cancer, a biopsy, a bad diagnosis such as diabetes or anemia or a condition where symptoms have persisted, suggesting the need for more and different medical investigations to help aid in a diagnosis. In those cases, even though the test has not found anything, it’s vital for the physician to close the loop.

“It’s extremely important to communicate with your patient,” said Dr. Martino. “If there’s a particular test with a particular complaint, such as knee pain, then we go back to the blackboard, and come up with a plan for diagnosis.”

Tracking results, he points out, is not a simple matter and he is particularly concerned about these missing test results you mention.

“What we hope is that physicians have a process in place to reconcile test results that have been sent out to be done,” said Dr. Martino, who is a member of Queen Square Doctors family health team in Brampton. “And we hope that is a strong and fulsome system. Certainly, for critical results, there should be a system in place to reconcile those and act on them.”

I, too, am particularly concerned about your missing test results and for that reason I would suggest you contact your family physician to follow up. That may also be a good time to discuss how you are able to learn of test results with abnormal findings. I would also follow the advice of Dr. Charles and to call ahead of your appointment to ensure test results have been received and to request the specialist, hospital or laboratory fax or send these results to your family doctor.

Lisa Priest is Sunnybrook’s Manager of Community Engagement & Patient Navigation. Her blog Personal Health Navigator provides advice and answers questions from patients and their families, relying heavily on medical and health experts.  Her blog is reprinted on healthydebate.ca with the kind permission of Sunnybrook Health Sciences Centre.  Send questions to AskLisa@sunnybrook.ca.

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26 comments

  1. Barb

    From the patient perspective, I think it is important that patients take charge of their own care. If tests are ordered, patients should inquire as to the reason for the tests. They should find out when the test finding will be returned to the doctor who ordered them and call to obtain the results. Depending on the nature and significance of the tests, the patient might request a copy of the results and keep them in an organized fashion with other health records.

    If test results that require follow up or treatment are inadvertently not communicated to the patient, the medical system will not be held accountable, so the patient or family must stay be proactive.

    • Linda alderman

      The Doctor and PA were both out and the PA said if anything showed up she would call.

    • Linda alderman

      On this same problem I was told by same PA if I was told again that I have a uti not to follow doctors orders to take meds until I first came to see her because it is not good to take so many meds for infection if there is no infection there and that meds are not always given for a uti.

    • David

      Any doctor who orders a test is solely responsible to communicate those results to the patient and/or other medical personnel caring for the patient. If the patient later develops a worse condition because the ordering M.D. didn’t communicate the results, that Doctor or hospital employee will be sued for malpractice and lose big time.

  2. Lisa Priest

    Barb,
    Thank you for those helpful tips on how patients can stay on top of their test results. It is useful information for those wanting to take charge of their care.
    While I agree it is important for patients to be proactive, I am also mindful that patients should not be burdened by things they cannot control, particularly the high users of the health care system who may undergo a series of very complicated tests by many providers. In such cases, it could be very difficult to ultimately track all the results. The best solution is likely an electronic one where all the results or copies of results are in one place and relevant results are communicated to patients and accessible to them.

    • Barb

      Lisa, I completely agree that patient/family involvement or empowerment should not replace or delay the development of ideal systems to appropriately transfer and relay information about test results. However, the persistent high rate of harm that occurs in the system demands that patients be encouraged to be involved in their care as much as possible. Most of the best medical systems of which I am aware are seeking ways to encourage patients to be more active and engaged in their care. I think of the involvement of the patient in his/her own care as being a necessity and not just a desire.

      • Lisa Priest

        Barb,
        Many systems do have patients very involved in their care and you rightly point out the challenges when the IT or ideal solutions are not there. I do agree the involvement of the patient in his or own care is a necessity. My simple wish was that this involvement not pose a burden to patients – the work to learn of a test result should not be an onerous undertaking.

  3. David

    Lisa
    An important topic especially challenging in an era of multiple health care providers, complex investigations and archaic information systems. Our goal should be a rational, secure single electronic health record, accessible by the patient and approved providers, where investigations (and of course other key data such as medications, past history, allergies etc) are posted, both as ordered and as completed. We should educate and empower individuals to become involved in their own care just as we are in other aspects of our life; while clearly practitioners bear responsibility to track and report the tests they order, a critical safeguard would be the oversight of she who is most central to the exercise, the patient.

    • Lisa Priest

      David,
      I couldn’t agree more with your comments. And I do believe many patients would be interested in their medical information if there was a convenient way to participate in it – such as the electronic option you suggest. When I receive questions such as this, I do worry how many other patients are faced with the same issue.

  4. Patient Commando

    I think there’s two critical issues here which speak directly to the patient/provider relationship:

    1. The competency of the family physician is suspect and it sounds to me like its time for retirement. Aside from poor record keeping, the attitude “its not his job to explain” is reprehensible. I know its tough to find a family doctor in a lot of places, but this patient might have a better health outcome going through the struggle. There’s no chance of getting quality health care from someone who doesn’t care.

    2. Labs won’t send patients copies of their test results. Only when this changes will the patient be properly empowered to be a participant in their care. It can hardly be expected to be the patient’s responsibility to track their provider’s test results when they’re prohibited from getting the information in the first place.

    Things must change on a couple of levels to deal with this patient’s specific issue.

    • Barb

      Thanks for your contribution, Patient Commando.

      In theory, and pursuant to the law, patients should be able to obtain their records from hospitals or doctors offices and if their request is reasonable, I have heard that most clinics and hospitals will share test results on the spot (especially while in hospital).

      With almost half a million views, everyone should watch E-Patient Dave deBronkart’s Ted-Talk.. Dave’s mantra is, “Give me my damn data.”

      http://www.ted.com/talks/lang/en/dave_debronkart_meet_e_patient_dave.html

    • Lisa Priest

      Patient Commando: Thanks for your comments. As you point out, it may be worth this patient looking for another family doctor. I have since heard from this patient who says the issue hasn’t improved.

    • Elizabeth Blackwell

      Absolutely right. This physician “who is not responsible” should be fired – by the patient and the hospital/clinic.

      I always ask for copies of the path reports -be sent to me for my records and one for my primary provider if applicable.

  5. Libby Guy

    I had been told that I need to wait for 5 weeks to see the doctor for a biopsy report because she is on vacation. I had a mole removed by this doctor, who said she didn’t think it was cancer and I wouldn’t hear from her unless the results were unexpected. I got a phone call from her office saying she wants a follow up so they booked the appointment for 5 weeks time!! The doctor is on vacation until then! I know that timely assessment and treatment is THE most important factor with regards to dealing cancer. I asked if they had sent the results to my family physician to which they answered they did not because the doctor likes to discuss the results with the patient first. What can I do about getting my results to my physician? It has been a week and a half and I am very stressed about this and I don’t believe I should have to wait.

    • Marias

      I am having the same problem with my specialist at the Vein and Vascular Institute of Tampa Bay. They will not give my referring primary care doctor who gave the referral for them to see the specialist the results of my CT exam. I had to call them after waiting for results when nobody from the specialist called in a week.

    • Krissy

      That is ridiculous!
      I cannot imagine waiting and stressing, that long, because the doctor is away for (5) WEEKS!
      That is a pretty long Va-Kay and too long for any human to wait for a result as important as yours!
      Changing physicians will not always be the way to go.
      Plus, once you have been to the same doctor for over 20 years, they should know you better than anyone.
      Nobody wants to start all over again, with someone who might not even do any better.
      I hope everything turned out fine~

  6. Krissy

    If my primary care doctor refers me to be evaluated by a physical therapy & sports medicine D.O. it would seem obvious, that the primary care doctor gets Cc’d everything.
    The office I was referred to, had me sign (5) “release of records”, so they could get my Radio Frequency reports, and MRI’S & CT Scans form the hospital.
    I fell during the “evaluation” when they commanded me to stand on my left leg. I stood there telling them, I cannot do that. It is the weak leg.
    “Do your best”.
    I could not hold onto anything, so I TRIED, and my leg buckled and I crashed into the table. There is NOTHING in his notes, that remotely says anything about that!
    In fact 5/5 was written for both legs! My left knee no longer jerks, and you could stick pins in my left foot and I would never know.
    They did write “abnormal” for every test with my right arm and wrist. I drop everything and being in the kitchen is now a danger for me.
    I have “protracted shoulders” and other noted cervical related problems including foraminal stenosis. He sat on this information for 7 months! Something about a inverted left rib impeding my left lung, which I now know, why that shooting, heart attack-like pain is coming from.
    My primary care doctor told me, he had NO notes on that appointment.
    I called back the sports medicine people, and they sent me another release form!
    I know I filled one out for him already, and I also know they did not want to disclose that I fell.
    I wrote up a comparable form saying “I want a copy”. I just got it yesterday.
    7 months of needless suffering.
    My primary care doctor order an MRI instead of a CT scan following ongoing agony from a 4 level cervical fusion. (the first 2 level fusion, fell apart. NOBODY believe me and the MRI did not show it.
    A CT-SCAN is the only test that will show anything with that much hardware.
    He did order the CT-SCAN but I could feel he was angry with me.
    “I did not know!” (the tone spoke volumes that he was embarrassed)
    Now its, “live with it”. “Nothing anyone can do”.
    He hates prescribing pain medication, but offers no alternative.

    I am disappointed in the lack of concern and the way I have to “kick” everyone along, to get results. It is annoying to see how doctors will not be forthright, when something goes awry during the consult. Reminds me of the police.
    I think it is terrible that results are not sent to the “referrer” automatically, especially when something is WRONG.
    It’s negligence, its laziness and its not helping me at all.
    More stress added to someone in chronic pain, makes the blood pressure spike.
    Someone should write an article: “Is your doctor making you sick?”
    I have every CT SCAN (on disc) every MRI every document from every place I have been referred to.
    Most offices will NOT accept it from me. “It has to be faxed by your primary care doctor”.
    WHY?
    I cannot change or alter a CT-SCAN.
    The office people get angry at me when their faxes do not go through.
    One office called them to say, “we only got page on”, so they had to re-fax it again.
    I ended up getting yelled at by the receptionist.
    Taking charge of your own care, means you will accrue more enemies.

  7. Rosemarie Verayo

    How long should I wait for my results?. My biopsy test was done at Sunnybook on March 15th, it’s already been 2 weeks, I was advised to follow up with my family doctor in 2 weeks , I called yesterday said no results yet. Do they need to call me even though the results is negative? But still… they should be calling patient as we have the right to know. We cannot assume everything is fine until we know.

  8. Lisa Gillotte

    My primary care doctor received results so that she could refer me to a surgeon. I made sure she received the results by going directly to the medical records department of the hospital and making sure they were sent to both my PC doctor and my gastroenterologists office. These tests were done in the ER. I was not sent by a doctor outside of the ER to have them done. I went because I thought I was having a heart attack. Turns out I have acalculous chronic cholecystitis w/ biliary dyskenesia. I didn’t realize this was a teaching hospital and a student wanted to operate however they fibbed to me. Having a degree in the health sciences, a dental hygienist, I have some medical knowledge. They tried to tell me I had a “huge” gallbladder stone that showed up on the CT scan. Having had a gallbladder US done 3 months prior showing no stones I was leary. They even admitted me to a room. I asked to speak to the surgeon and let’s just say to make a long story short he was not being on the up and up, not making sense. I was very uncomfortable trusting what he was saying. I left wanting to see my gastroenterologist for a referral to a surgeon. I was given paperwork for a peptic ulcer upon discharge. I had an endoscope by my gastroenterologist 3 weeks earlier with no peptic ulcer. After seeing the CT results myself, there were NO stones. “Acalculous chronic cholecystitis” on the HIDA scan biliary dyskenesia. Both my PC and gastro received the results but never called with a referral. I couldn’t get past the front desk staff at the gastro to get a sooner appt. Waited for my previously scheduled appt. and the results were in the computer but the Dr. never saw them. I said ” Isn’t the Dr. Supposed to sign off on test results that are faxed over before they get stashed away in the computer” and they said “yes, usually they are” I was then referred to a surgeon and am scheduled for surgery this week. Still haven’t heard from my PC at all. Have a previously scheduled appt. w/ her tomorrow. I suspect she hasn’t seen them either. So, in this case, it’s not that the lab hasn’t sent results, which I agree if that happens it’s the Drs responsibility to make sure they receive results they send out, Why aren’t these Drs.signing off on results (looking at them) before the front desk illegally, essentially makes a diagnosis on their own and files them away? Are Drs required to look at/sign off on test results received by their office. What if someone has cancer, needs a referral, and never knows or receives it? Another reason I wanted a surgeon I trust is because I have been ill for quite some time, took forever for Drs to figure out, took forever to get testing, took forever to get a referral and when my grandmother went in to have her gallbladder removed, she was filled with cancer, closed up and died 3 weeks later. It was too late. Thank you. Sorry, about the lengthy comment w/ one main question. 🙂

  9. Linda alderman

    I was told on three different visits that I have uti. This was in April of 2016. I was told agin by my doctor of a uti at which time I went back to see Pa at doctors office ( my regular is out on medical leave ) The PA told me the X-ray I had in April showed several large stones which would require surgery since they were too big to pass otherwise. I told her how upset I was that I have had a uti for so long and she had not called to tell me of results of X-ray. Her comment was Sorry Doctor has been out sick and I had family emergency that’s all I can say. This is not exceptional to me and definitely not what I would expect from my doctor. I have had a lot of problems , pain and constantly sick on my stomach. What measures can I pressure on this?

  10. Suzanne McDonald

    The Doctor will call if there is a problem. What if there is a problem and decisions are made that impact your health and financial future? Example: There is a health issue of IPF in my family, I have always had negative results from previous x-ray from yearly check ups. The year before I retired early due to poor health, my x-ray showed a change in my lungs which I was not made aware of and a diagnoses of IPF was eventually found. To retire early reduced my pension, I also lost the chance to use my sick leave and going on sick leave benefits from work. Also same Dr. did not relay to me a result of reduced bone density for 5 years. To treat conditions early should help one would think. I am really angry. What should I do?

  11. David

    Allowing doctors to shift the burden of tests results on patients is not going to work. If a doctor orders a test, that doctor is 100% responsible….period.

  12. Mary

    Can a GP order a brain CT scan, even though I am being followed by a neurosurgeon?

  13. danielle

    so what do you do when the doctor tells the patient they will not give them the results, even though it was sent to the office and confirmed, of the test they just had because they went out side of the hospital to save money? and tell the diagnostic center to give them the report.

  14. Yvonne

    I have had my right knee replaced a few months ago and I am now in, out patient Physical therapy. It coming along but slower then I and my doctor thought. Today I had an appointment with my Othoptic surgeon. Before I had my surgery the Othoptic doctor saw that I had a cyst in my thigh bone right over my knee. He didn’t want to do a biopsy so he ask for previous X-rays from a few years ago so I gave him them to him. The doctor decided the it had not change since the last x-rays and was the same as the one he took. He went ahead with the surgery, feeling that it was not cancer but a benign cyst. On my second visit after surgery and second x-ray since surgery the cyst had changed in shape. The doctor did not discuss the cyst with me or ask was I experiencing any problems because of it. I happen to see it on the way out of his office. I told him it looked ugly and he did explain he just changed the screen. I didn’t think to much about at the time. When I went home it stay on my mind so I look up if your cyst burst what could happen. I find out the you could get blood poisoning. I also looked up could your white bloods cell be high if that happened. The answer was yes. The reason that was important to me, was because I am getting over a UTI and my white blood cell was very high. It could have been from a stomach virus I had just before I got a UTI. But, now I’m not sure. I will check with my primary about my test. But, what do I do about my Othoptic doctor?

  15. M. Carol Clifton DeMott

    This sounds great but I had testing done. The doctor was sent the results the same day the test was done. In the meantime, I have to have sinus surgery and would like to get my other results before surgery. The doctor has refused to give me my results and told me go have your surgery. The staff told me the results were abnormal and it was something relating to my upper pelvis. I have been suffering with severe pelvic and stomach pain. I had to go to the doctor twice before he would run a cat scan and now won’t give me the results?? Should I be calling my lawyer. I am in chronic pain. This doctor needs to be reported to the state of Texas.

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