In the outpatient setting, up to a quarter or more of abnormal test results are not followed up in a timely manner, according to a commentary published this week in the Journal of the American Medical Association (JAMA). For patients, it's a highly dangerous communication gap, and for physicians, it's an expensive one, now costing U.S. doctors $91 million in annual medical malpractice payouts, as reported in a recent study in the Journal of the American College of Radiology.
Despite the severity of the problem, however, little consensus exists regarding the best solutions. Although the Department of Health & Human Services recently proposed changes to state laws to allow patients direct access to lab results, the jury is still out as to whether that approach would cause more harm than good, according to the authors of the JAMA commentary.
"We need to be balanced and think of both intended and unintended consequences that might result," Dr. Hardeep Singh, senior author of the report, said in a press release. "At this time, we do not have all the answers about what the best practices might be. The scientific knowledge needed to develop these best practices is still evolving," added Singh, assistant professor of medicine and health services research at the Veterans Affairs Health Services Research and Development Center of Excellence and the Baylor College of Medicine.
In the meantime, experts recommend being clear with patients about how your practice handles test results and instructing them when to follow up. Although the volume of test results can be staggering for doctors to keep up with, a "no-news-is-good-news" policy is simply not acceptable, Dr. Glen Stream, president of the American Academy of Family Physicians, told NPR.
In his own practice, Stream is very specific with patients and promotes making them "part of their own culture of safety," according to NPR. "I tell them, 'I'm scheduling a CT scan of your abdomen, and if you don't hear from me in three days, call me.'"
To learn more:
- read the article from the Washington Post
- see the post from NPR
- read the commentary from JAMA
- check out the related press release from the Baylor College of Medicine