Direct lab results don't diminish docs' role in care

This morning, out of simple curiosity, I logged on to my primary care office's patient portal to check the results of the routine lab work I had done a month ago. Because I use this service so infrequently, however, I had to try a few passwords before stumbling on the one I'd most recently reset (usually I can't remember my login info at all). Within my account was a provider letter dated Feb. 3 (a hard copy of which I should get in the mail probably today) stating everything was in range and there were no major changes from last year.

Fair enough. The news (or lack thereof) was about what I'd expected, and I probably wouldn't have even bothered to check had I not read the announcement from the Department of Health & Human Services that a new amendment to the Clinical Laboratory Improvement Amendments of 1988 regulations boosts access to completed lab test results for patients and designated patient representatives.

FiercePracticeManagement reported on HHS' proposal to make this change back in September 2011, describing the dilemma it posed for physicians. On the one hand, giving patients direct access to their lab results posed the risk that patients would misinterpret or overreact to the data. On the other hand sat the longtime problem of important lab results never reaching the patient at all, exacerbated by a popular "no news is good news" policy among medical offices.

Also in the "pro" column, according to officials at Quest Diagnostics and other proponents, is that giving patients more control of their information will boost engagement, as noted in a post from Kaiser Health News.

As a patient, I see the validity to all of these arguments, but I don't believe this rule change solves any more problems than it creates, or vice versa.

In a perfect world, patients would receive the lab results from their doctors in a timely fashion--and have the ability to look at the hard data themselves.

Consider the example I gave at the beginning of this column. In the not-too-distant days before patient portals, I got a call from my doctor that my iron levels were out of whack. It was a simple and easily correctible problem, but given that I'd lost a blood relative to leukemia less than a year prior, any anomalies involving blood cells set off internal alarms that would have been nonexistent in a different context.

This anxiety aside, I also needed information about terminology many of us think we understand but don't really--in this case the difference between iron and ferritin levels and what it means to be anemic. Depending on my mood at the time, I could have looked at my exact numbers on my own and interpreted my iron levels as being perfectly fine--or my ferritin value placing me on death's door. A five-minute phone call with my doctor put everything in the correct perspective.

But, like I said, that doesn't mean I'm against direct patient access. I've also had the unenviable experience of waiting weeks for the results of a test to determine my genetic risk for breast cancer. Before submitting to the test in the first place, I'd agreed with my doctor that we'd discuss options once we gathered the facts. I was mentally prepared for the worst and ready to make a decision later made famous by Angelina Jolie.

Given those circumstances, if I'd had the ability to get those results any faster or more directly, I'd have taken it. I'm sure my doctor's office, too, could have done without my weekly phone calls to check. Either way, a follow-up conversation with my doctor was inevitable. When I finally did learn that the test had been negative, my doctor reminded me that it did not mean I was immune to breast cancer--that my risk was simply the same as any other woman who did not carry a genetic predisposition. Getting the news on my own a few days earlier would not have traumatized or confused me one way or the other. The main anxiety I was feeling was from waiting--and I'd have welcomed the test results a minute sooner to relieve that worry.

Regardless of the pros and cons, however, HHS has made the decision and now you need to figure out how you will live with it. So let me ask you, how will this rule change the way you handle and communicate lab results with your patients?

I probably don't need to tell you that there is a lot more to lab results than meets the eye, but I hope that by sharing some personal experiences you will continue to appreciate the importance of your role in discussing these matters with patients, as early and as empathetically as possible.  - Deb (@PracticeMgt)

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