Diagnostic test results. What do you tell the patient?

[dudette10, MSN, RN]

This is a subject I'm still confused about. Let's say you have patient that has gone for diagnostic tests. The results are available, and you know what it says. The patient or family asks about the results.

I've had some nurses say to tell the patient, and I've had others say that's the doctor's job and out of our scope to interpret diagnostics for the patient or family.

This is what I do, and I hope you can give me feedback on whether it's right or wrong. If the official diagnosis has been made, I'll tell them that's what the diagnosis is. "You have pneumonia, and the doctor has ordered antibiotics that I will be giving as scheduled." If the doctor has not yet made a diagnosis, I'll explain that the results of the diagnostics will be interpreted by the doctor and that the doctor will talk to them about the results. "The lab test is usually done to determine if you have a respiratory infection, given your history and your symptoms. The doctor will be able to explain the results to you on his rounds."

What do you do?

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

It's up to the doctor to interpret the test results. Always, always always. Especially should a patient read their own chart! Go out on a limb and share results with a patient and I guarantee the patient will say "but the nurse said!" Then you're in deep yogurt. If a patient knows a test result for some reason, again, the doc will interpret it is your answer. Not worth the trouble you'll have any other way.

[nerdtonurse?, BSN, RN]

If the results are good and the patient is frantic at 3 am (am I having an MI? do I have cancer?) I never, ever tell them "oh, you're ok." What if they're not? What I might say if I think the not knowing could be causing harm is, "The results are in, and while I'm not legally allowed to discuss them with you, I can tell you that the doc has not ordered any new meds or treatments at this time." Truth, and saying nothing.

I've if it's bad, I tell the patient that some lab results take days to come back, and then have to be reviewed by an MD to make heads or tails out of it, because it's true. Theirs may be back, but labs can take days to come back.

Use your pneumonia story. I'd say, "the doc's looking at a variety of things, and wants a good broad spectrum antibiotic given in case you have an infection somewhere in your body. As the tests come back, they may change the antibiotic for one that will get exactly what you've got, or do something completely different." If you said pneumonia -- and then they find a lung CA nodule under the infection in the lung -- that could be a really bad day at the office.

And I've worked a lot of nights where my patient thought they were going home in the morning after their lap chole, or their colonoscopy or EGD, and I knew they were going to an oncologist because we'd made the appointment. They're all bright eyed, "yippee, going home, feeling better" and I'm thinking, "this morning, a doctor is going to walk into this room and change your life forever. The silly things you are worried about now like something that was said at work, or what role your kid will get in a play, or should you get that new car or wait -- all of those things will fall off the radar. Instead, your life is going to revolve around MD visits, chemo, radiation, and the threat of dying much too young, and the results of radiology and labs. You may survive, or you may be a dead man walking, and right now, you think you've got forever. And you don't."

[merlee]

It is not good practice to divulge test results - it is what the docs are paid to do, and there are reasons for that. Do not put yourself in the line of fire!

Best wishes!!

[Biffbradford]

I usually say "they aren't back yet" or simply "I don't know" and that's all I'm saying on THAT! :saint:

[Esme12, ASN, BSN, RN]

I really think it's the MD's job....isn't that what they get paid for? If it's in the middle of the night and I have to give K+ because they had a run of VTach that lead to drawing the lab that showed the K+ of 2.5 ....I will tell them their heart had an irregular rhythm that can be caused by a low potasium so the labs showed it is low and the MD ordered it to be replaced.......anything else, I will lie and tell them "all the tests aren't back yet" or "the doctor hasn't looked at everything yet......and He'll (the MD") will be here first thing in the morning. If they get crazy I will call the MD at home and ask him to speak to the family or what can I say to them as they are driving everyone crazy.

[Been there,done that, ASN, RN]

If the results will relieve their anxiety.. I just say.. I am not allowed to give you these results.. it has to come from the doctor, but I can tell you I am very happy for you.

If it is bad news...I wouldn't touch it with a ten foot pole.

[bjaeram]

In general I think it's the doctors job but at times I do share.

I WILL NOT treat something if the patient doesn't know what is wrong. I'm not going to walk into a room and give an antibiotic or potassium without the patient knowing why I'm doing it. In those cases I will tell them.

Usually I tell them the doctor will be in to go over the results. I won't lie and say they aren't back. i just say the doctor has to go over them so he can answer any questions. If the patient is anxious or the doctor is taking forever I will review results, read the xray reading, read the labs to the pt. I will not interpret them or tell them what the plan might be. I just read straight facts. I think that is okay. Of course if it's something horrible I dont' go there. They will have 4million questions I"m not qualified to ask.

[EDnursetobe]

I don't tell the patient, I feel that's up to the doctors for the most part because they ran the test, and they know more of the details.

However I will say something like "your K+ was low and the doctor wanted you to get a supplement" before giving it.

[leslie :-D]

i will NEVER share labs results again.

we had this complicated ca pt, who had managed to fight her ca well beyond her expected prognosis.

her dr. had ordered specific labs and it seemed her ca was aggressively worsening.

i shared this with her adult dtr, who went crying, into the arms of her mom.

well.

evidentally to this particular ca pt, these lab results meant nothing.

and she was FURIOUS with me, that i had shared them with her dtr.

pt eventually forgave me; transferred out of hospice facility to live near family in another state...

and from what i heard, she lived another 4 yrs before ca finally beat her.

anyways, after that experience, call me paranoid, but i let the docs do what they're paid to do.

leslie

[DixieRedHead, ASN, RN]

"The doctor hasn't reviewed them and made a diagnosis yet" is as far as I'm going and that's it.

[canesdukegirl, BSN, RN]

I don't say 'the results are in' even if they are good. That's just adding to the pt's angst. I won't hint around. I page the doc and let them know that the pt has questions regarding test/dx results.