Is No News Good News?

LaurieCRNP2002, MSN, RN, APRN · Apr 7, 2000

Hello!

I am a nurse who works in an acute care setting, so I'm not necessarily familiar with "office nursing". However, my general feeling is that patients should be contacted about the results of tests regardless of whether the news is good or bad. Let's face it, most people only go to the doctor (or hospital) if there is a problem...with all the limits HMO's and managed care places on consumers, I would venture a guess that very few people go to the doctor for "annual checkups" in this day and age. I will say, however, that if the labwork involves testing for blood levels of a drug, the "no news is good news" policy is probably ok, because if the patient's medication needs to be adjusted, the doctor should be calling the patient (and if they're not, shame on them!) Basically it comes down to each person's comfort level...if a patient wants to be informed of a test result,whether it's good or bad, they should let their doctor know this,and if the doctor resists, go find a new one! Hope this helps you out!

Laurie, RN

maikranz · Apr 7, 2000

My per diem position is in a FNP private primary care practice. We always log what lab tests are drawn, radiology studies, mammography, etc. Each result has its own turn-around time and If we don't hear, we call. CLIA '88 mandates certain things depending on the size of the practice, but doing some QA things just make sense.

For clients, we always call abnormal labs. If we can't reach the client, we send a letter asking them to call the office. We used to call normal labs as well; now we send a letter, and if there is a specific area of client concern, we make a point of mentioning that area. Other diagnostic studies get a phone call attempt and a letter; mammograms always get a call, normal or not.

It doesn't take any more time to call. When clients call the office looking for test results, you must pull the chart anyway so that you can answer questions, so it's just as easy to call.

Good luck with the article.

Margy · Apr 8, 2000

Hi Karen... Im from Australia and many of our GP's run on the 'We'll call you if there is a problem'system.This practise is subject to error and I would be advising any patient to ring for results of all tests and when they do, should get their name and DOB verified and the result read to them over the phone. (This can only happen of course if the results are clear, if there is a problem this must be discussed face to face in the consulting room.) This ensures that

a. You are GETTING a result and

b. It is YOUR result.

We had a recent case here where a woman had a breast bx and was told she would be rung if there was a need. She was 'missed' in the system and and as a result has 12 months to live at best. She is 32. The case went to court and she was awarded some 500,000 dollars, a paltry sum for loss of life.

Doctors in my medical facility were dismissive of her case and hostile to her making a claim... can you believe it?

Tea room talk was volatile and strained during the trial as it had huge ramifications for all medical staff.

I hope this helps with your query.

Marg

MollyJ · Apr 8, 2000

I've never done office nursing, but have some proximity to the issue.

This is a problem that has no easy solution just because of the sheer mass of paper work. Let's say a doc sees 40 patients in a day. 17 of those get labs; some are strep screens, some are CBC's or situations where there is one test per one person and relatively easily tracked. A couple of people come in for blood sugars; they're diabetics and want/need to know the result even if it is normal. a couple of preg tests [they wanna know]. Some people come in and have a chest x-ray (to track known heart/fluid problems) and a lipid profile come in. A couple of people have CBC, lipids, multi-chems, and are scheduled for a treadmill and a mammogram. In these latter cases, all of the results will come back on a different day, scattered over days, weeks or up to a month (depending on the treadmill lab or mammo's scheduling book and the patient's life schedule). It ALL comes across either the doctor or nurses desk for review. The fact is, some people need a call back and the others don't.

In my own doc's office, she notifies by exception (if it's abnormal) except for mammo's and pap smears. Since I haven't had treadmills and other testing, don't know. I'd guess some docs will bring you back to discuss those tests. I got a phone message telling me to continue my low fat diet, re my lipids once. Other times, I've heard nothing.

To say ALL labs, xray's, other tests need to be phoned back to the client is to create a huge burden that may be unnecessary. The fact is that sorting through the masses of data that passes over a FP's or IM's desk on a daily basis in a busy practice is a HUGE paperwork task that _must be done_. I think saying, "Everything get's return notified" potentially creates an undoable care burden that results in nurses and doctor spending lots of time caring for paper and not people.

Frequent this and other boards and you will see that this is a common complaint: "I take care of paper, not people."

I'm not denying the tragedy of critical labs that don't get notified and I'm not excusing. I want you to have a little insight into how big of a job this can be in an average practice.

Patients can and should:

*View themselves as partners in the care process. Make it easy for the nurse/notifier to find you. That means correct phone numbers, addresses, work numbers.

*If you don't hear back and are curious call them. If your aunt Selma and your mom had breast cancer and you haven't heard back from your results in a week or ten days, call back.

*Know at the end of the visit, what the notification plan is. Will they call if problems, notify you by letter, expect you to call in? If the plan doesn't come off as expected or if they don't call as promised, or there is no plan to call you be your own advocate and call in for lab/test results.

*If the lump or the problem or symptom gets worse, go back. You live in your body and you are the only person that will know this info. You may feel silly or sheepish or whatever, but go back. Maybe the doctor said, I think this is viral, but we'll do a strep screen and you'll hear from us if it's positive. You don't hear from them, but things are getting worse. Go back. Maybe you had an unreported positive, maybe you had a false negative, maybe you've evolved a new problem. Go back.

*Your doctor and his/her office staff are humans. They may make mistakes. If you haven't gotten the info you want, call 'em back, reappoint, do whatever.

Now, finally. In the area of risk managment/error control, there is a movement toward making the system more of an assistant in averting errors. I suspect that the doctor's office is a little under-studied in this sense. There has been a lot in the news, for example, about how pharmacy systems can reduce error, or how the engineering of equipment in a uniform fashion can reduce error. I suspect this is an area that would benefit from similar intervention. While I think office systems are critical in this problem, I think the patient must never underestimate their own importance in the scheme and take an active role in assuring their own involvement in their own care.

darla80 · Apr 9, 2000

Originally posted by MollyJ:
I've never done office nursing, but have some proximity to the issue.
This is a problem that has no easy solution just because of the sheer mass of paper work. Let's say a doc sees 40 patients in a day. 17 of those get labs; some are strep screens, some are CBC's or situations where there is one test per one person and relatively easily tracked. A couple of people come in for blood sugars; they're diabetics and want/need to know the result even if it is normal. a couple of preg tests [they wanna know]. Some people come in and have a chest x-ray (to track known heart/fluid problems) and a lipid profile come in. A couple of people have CBC, lipids, multi-chems, and are scheduled for a treadmill and a mammogram. In these latter cases, all of the results will come back on a different day, scattered over days, weeks or up to a month (depending on the treadmill lab or mammo's scheduling book and the patient's life schedule). It ALL comes across either the doctor or nurses desk for review. The fact is, some people need a call back and the others don't.

In my own doc's office, she notifies by exception (if it's abnormal) except for mammo's and pap smears. Since I haven't had treadmills and other testing, don't know. I'd guess some docs will bring you back to discuss those tests. I got a phone message telling me to continue my low fat diet, re my lipids once. Other times, I've heard nothing.
To say ALL labs, xray's, other tests need to be phoned back to the client is to create a huge burden that may be unnecessary. The fact is that sorting through the masses of data that passes over a FP's or IM's desk on a daily basis in a busy practice is a HUGE paperwork task that _must be done_. I think saying, "Everything get's return notified" potentially creates an undoable care burden that results in nurses and doctor spending lots of time caring for paper and not people.
Frequent this and other boards and you will see that this is a common complaint: "I take care of paper, not people."

I'm not denying the tragedy of critical labs that don't get notified and I'm not excusing. I want you to have a little insight into how big of a job this can be in an average practice.

Patients can and should:
*View themselves as partners in the care process. Make it easy for the nurse/notifier to find you. That means correct phone numbers, addresses, work numbers.
*If you don't hear back and are curious call them. If your aunt Selma and your mom had breast cancer and you haven't heard back from your results in a week or ten days, call back.
*Know at the end of the visit, what the notification plan is. Will they call if problems, notify you by letter, expect you to call in? If the plan doesn't come off as expected or if they don't call as promised, or there is no plan to call you be your own advocate and call in for lab/test results.
*If the lump or the problem or symptom gets worse, go back. You live in your body and you are the only person that will know this info. You may feel silly or sheepish or whatever, but go back. Maybe the doctor said, I think this is viral, but we'll do a strep screen and you'll hear from us if it's positive. You don't hear from them, but things are getting worse. Go back. Maybe you had an unreported positive, maybe you had a false negative, maybe you've evolved a new problem. Go back.
*Your doctor and his/her office staff are humans. They may make mistakes. If you haven't gotten the info you want, call 'em back, reappoint, do whatever.

Now, finally. In the area of risk managment/error control, there is a movement toward making the system more of an assistant in averting errors. I suspect that the doctor's office is a little under-studied in this sense. There has been a lot in the news, for example, about how pharmacy systems can reduce error, or how the engineering of equipment in a uniform fashion can reduce error. I suspect this is an area that would benefit from similar intervention. While I think office systems are critical in this problem, I think the patient must never underestimate their own importance in the scheme and take an active role in assuring their own involvement in their own care.

darla80 · Apr 9, 2000

Originally posted by Karen Cicero:
Hello. My name is Karen Cicero and I am a reporter for Self magazine. I was hoping that nurses could shed some light on the "no news is good news policy" that many doctor's offices have for test results. Do you believe that such a system benefits the patient? Do offices have safeguards to track results that might not have come back from the lab? Are results ever lost or misfiled? I'm just looking for advice to give to our readers (20 to 45-year-old women) on this issue....when their doctor says, we'll call you only if there's a problem, what should the patient say? Any help would be greatly appreciated. Thanks a bunch! --Karen

darla80 · Apr 9, 2000

I am an office nurse in a very busy internal Medicine practice. I might add that I work in a one physician-one nurse practice. As an Internal medicine practice we do alot of labs and order many tests.

I track all tests and ensure that results are placed in the chart for physician review. This is a daunting paperwork task but these tests were ordered as part of the diagnostic evaluation and the results are important to the physicain ordering the eval and to the patients.

My advice to every patient in our practice is this "As a patient you have a right to an explanation about the results of the tests/labs. Even if the results are all normal we like to discuss these results with you. I tell each and every patient that if they do not hear from me within a week of the day their lab/test was done then it is thier responsibility to call the office so we can review the results. Some of the burden for follow up should lie with the patients.

People need to be responsible for their health. If we as healthcare professionals hope to help people attain an optimal health standard then we need to help them understand the power that can be gained from knowledge about their own bodies and minds.

We do have our share of patients that want to me to hold their hands. They even ask me to call them when thier next lab is due. Tell your readers if they have an abnormal lab or test result and thier physician wants them to retest in 3 months they need to be responsible for themselves. I suggest that they put the followup lab notice in their datebook, tuck it in the calendar or use whatever approach they use in remembering important things. Do not expect the nurse in the physicians office to call and remind you to have the lab rechecked. Our most succesful approach is to schedule the patient for a follow up visit to the doctor at the time they need the repeat lab. People are a little more attentive to appointments but still many people forget or come to the appointments without having the lab drawn first.

If we are expecting abnormals or the test is of a more serious matter we try to have the patient schedule a follow up appointment before leaving the ofice.

IN A NUTSHELL... My advie to your readers: TAKE REPONSIBILITY FOR YOURSELF.

BE INFORMED. THE PHYSICIANS OFFICE AND YOU ARE PARTNERS IN PURSUING GOOD HEALTH.

GOOD LUCK WITHYOUR ARTICLE!!

Originally posted by Karen Cicero:
Hello. My name is Karen Cicero and I am a reporter for Self magazine. I was hoping that nurses could shed some light on the "no news is good news policy" that many doctor's offices have for test results. Do you believe that such a system benefits the patient? Do offices have safeguards to track results that might not have come back from the lab? Are results ever lost or misfiled? I'm just looking for advice to give to our readers (20 to 45-year-old women) on this issue....when their doctor says, we'll call you only if there's a problem, what should the patient say? Any help would be greatly appreciated. Thanks a bunch! --Karen

[This message has been edited by darla80 (edited April 08, 2000).]

mcrow · Apr 11, 2000

At our clinic, some of the doctors schedule the patient to come back for test results unless it is routine lab. Other doctors keep a log of test results they are expecting and call the patients with abnormal results. Most normal test results are not called. It is expected that in those cases if the patient continues to have problems they will come back in.

Babette777 · Apr 16, 2000

Hi! I'm a registered nurse working in a private practice in Australia. The Doctors that I work actually encourage their patients to call the clinic and get their results. I would say about 80-85% of our patients do call back for their results within a few days of having their tests done. I the patients don't call back and the results were considered "normal" by the GP's then I guess the no news, good news rule applies to these patients. If the patients don't call back for results and doctors are concerned with the outcome of the tests they get us to call the patients in for a f/u.

We have a computer program that is always linked with the pathology lab that do the tests for us and the results are downloaded automatically into our system 5 times daily. So, when patients call we can look up the results on our computer in a matter of seconds... if the computer is happy that day. If we can't get the results from the computer we call the pathology and get the results faxed over ASAP so that the patient can have piece of mind. All this is very time consuming but all part of being in private practice. The patients really appreciate knowing what is going on ... be it good or bad.

YADA-YADA · Apr 16, 2000

I feel the doc should notify either way, good or bad that way I know he as at least looked at the results.

Recently my husband went and had his ankle x-rayed and the MD never called back to give him a result and assumed it was okay. Two weeks later my husband went back to MD for a different reason and asked about his x-ray. Well guess what the doc had not even looked at it yet!!!!

Luckily it was okay, but what if it wasnt?

Very dangerous practice!!!!