Diagnostic test results. What do you tell the patient?

[dudette10]

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?

[xtxrn, ASN, RN]

Not a black or white question for me.....totally depended on what the test was, and how much the doc had discussed with them prior to the test.

IF someone went for a CT or MRI to r/o a specific diagnosis, and the patient knew what the treatment would be following that diagnosis, I would look up the interpretation on the test results, and tell them the doc would get into the specifics, but a) the preliminary report is looking good or b) the doc will get into the specifics of the test results.

If it's a known diabetic, who is asking for their A1C, cholesterol, LDL, HDL, triglyceride, BUN, Cr levels, I'd tell them. They knew what their "usual" results were. If it was a known warfarin patient, I'd let them know their PT/INR- and print a copy if they wanted it.

BUT- with all of the above, I'd be sure the doc knew the results first. If it was a sensitive situation, I'd ask what I could discuss with the patient.

The Onc. floor I was on had cards with space for a weeks worth of lab results- every day, the nurse took the card and filled in the results- it was a HUGE help to see what was going on, and any progress or problems. :)

[MassED, BSN, RN]

This is an interesting post.

Some things I share, some things not so much. I DO believe in being forthcoming with diagnostics (explanation of tests as well as what they are looking for or ruling out) - when results come in, 99% of the time, we're slammed and the doc can't get in there, so I say "your CT of the abd/pelvis showed ? appendicitis so they're paging surgery to evaluate you. The ER doc will be in to discuss more with you as soon as he/she gets out of our trauma room." I believe in letting someone know of cardiac markers, if they're + or - and what that means in the grand scheme of things. I tell them their EKG appeared normal (because I can interpret these things) but also tell them that their EKG can be "normal" but that is only one piece of the puzzle and even with negative biomarkers, you can still get your turn in the cath lab. I like to be completely neutral, but honest. I like to know what is going on, so I appreciate communication on all levels - I communicate to patients - they can deal with their families. I try not to get involved in sharing with families unless patient is confused. I do, ultimately, leave everything up (a final clarification of plan) with ER doc or admitting docs. I leave myself an out so as not to be the final word. It is unfair for a person to have to wait and worry. Many times we are the only ones they see and provide information, so I try to be as clear about how the whole process works - since many are surprised at how a hospital/admission, etc. even operates. I haven't had any issues at any time with labs/diagnosis, etc.

I did once ask a younger man (maybe in his 40's) who was at the bedside of who I ASSUMED was his mother... ask "what's your son's name?" and was horribly embarrassed to find out they were man/wife. YIKES. She was a good 20 years older. I never make that mistake by assuming how people are related, I always ask "and how are you related, are you family?"

[Jenni811, RN]

depends what it is. If the patient is curious about their INR or their WBC, i will tell them.

If is it results of an MRI that was detecting a brain tumor, i leave that to the doctors.

[nurseprnRN, BSN, RN]

"what did the physician tell you?" sometimes they already did explain it, and you now get to reinforce/correct misapprehensions.

there are plenty of things that patients, particularly ones with long-term illnesses they've been managing, know already. if they ask you, tell them their crits or their amylases or their cd4s....

as for me, if i ever have a nurse say, "oh, you'll have to ask the doctor about that," i'd spit in her eye. i actually did have one say that to me when they brought me my newborn with ekg suction-cup hickeys all over her tiny chest after i had already refused permission to do one, because the only reason she was relatively bradycardic (118) was because she was breastfeeding and i was getting dilaudid for my necrotizing fasciitis (thanks, july house staff, for the through-and-through stitches into dirty places!). there was nothing on it, of course. people are entitled to have their questions answered timely, about their own bodies or those of their children/wards.

you can certainly say, "your potassium was a bit lower than normal this morning, so i'm giving you a bit extra," or, "the xray report (which is read by a physician) says it looks like you have a little pneumonia in there (if that's all it is)," and if you can't figure out how to interpret a finding, tell them that. but none of this dancing around and playing dumb.

[loriangel14, RN]

Where I work we are not allowed to discuss any results unless it's something simple like a UTI or a low hemoglobin.

[nurseprnRN, BSN, RN]

is that in writing somewhere, or is it just one of those unwritten conventions without rational basis? ask.

[AnonRNC]

I think it's unwritten. I work in the NICU where the nurses have some autonomy. If it's a Big test, I defer to the doctor. Ours are good about coming right away if I call and say "Baby Smith's test is back." I do not report results of head ultrasounds or echocardiograms.

But if it's the "usual" stuff, I'm comfortable saying, "The doctor has final say, but I don't see markers for infection on your baby's CBC" (if it's SPOTLESSLY clean). Or "Her crit was down a bit this week from 33 to 30. Typically, our doctors transfuse only for crits less than 20, but Dr. Jones has final say on that."

A lot of the time, I say things like "When I see these symptoms/test results, the doctor TYPICALLY orders...."

[dudette10, MSN, RN]

Thank you all for responding. It sounds like you all have drawn from bad/good experiences, how much autonomy the nurses are given in a particular unit, how much the patient already knows and has discussed with the doctor, and even the relative seriousness of what is going on.

In other words, there is no black or white answer. Someone gave the example of arrhythmias d/t K+ levels, and yes, I've answered the exact same way when I'm delivering that red-lettered bag to hang or asking them to swallow those awful horsepills. Same with PT/INR levels in which I need to hold or give Coumadin. (Don't have to deal with that much any more since I work nights now, though.) Hanging blood or antibiotics also deserves a thoughtful answer.

I appreciate your responses, and they were all very helpful. As a newbie, it's often difficult to swallow the fact that it depends on the situation and there is no tried and true script to follow. As a new nurse, I am often faced with not only "did I do the right thing," but also "did I say the right thing."

[seizetheday]

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.

I would never ever lie to a patient about why they are taking a medication. Patient's have a right to know what medication they are taking and why. If there are results back that say pneumonia and they should know that is what they have and that is why they are being given an antibiotic. Would I tell the diagnosis - no, would I lie and give the med, no. i would call the doc and say you ordered x and pt doesn't yet know diagnosis. If doc told me to tell i would, otherwise I would hold med till the doc has spoken to the patient.

I have health issues and if someone lied to me about why i was being given a medication or treated me like I was stupid I would be livid.

[dudette10, MSN, RN]

The disagreements are as interesting as your own personal stories about how/why you do things.

Pneumonia can be a killer (it killed my stepmother), but it's a dx that doesn't strike fear in a lot of people like ca, MI, or CVA does. We've had patients come up from the ER with PNA as the admitting dx and the PNA protocol started. I feel comfortable saying I'm hanging this abx for PNA, if that is the official dx. Haven't gotten in trouble for it...yet.

[nurseygurlie]

"The preliminary results are in, but the doctor hasn't reviewed the results yet. As soon as he comes in, I'll be sure to request that he go over the details with you."

"The results of your test indicated a possible infection. The doctor hasn't made an official diagnosis yet, but as a precaution he has ordered some antibiotics."

"Once the radiologist submits his report of your scan, the doctor will review and interpret the scan along with your signs and symptoms, other lab work, etc. Because the results of the scan is only one piece of the puzzle, it would be inappropriate for me to try to interpret them for you."

"I don't have information to give you regarding what this means in terms of your diagnosis. What I do know right now is that your potassium is below normal and the doctor has ordered a supplement to help bring you back to normal levels."

[MunoRN, 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.

What "law" are you referring to? I agree we shouldn't notify patients of interpretations that are out of our scope. But if the patient goes for a CT, and the radiologists reads the CT as showing a PE, are you saying you wouldn't "legally" be able to tell the patient the CT showed a PE?