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?

[dudette10, MSN, RN]

To give an example of when I didn't say something...

Had a patient come up with AMS and suspected TIA with progress notes indicating resolved symptoms. My assessment was a bit different, and the admitting doc ordered a stat CT. The daughter was concerned that her dad was being taken so quickly for the CT. Reading came back as acute infarct, but it was too late from onset of symptoms to start fibrinolytics and ASA had already been given in the ER, so my post-CT orders were fairly routine. When asked about the results, I punted to the doctor. Not sure if that was right or wrong, but that was the only response I felt comfortable with.

[Biffbradford]

If I'm sprinting into the ICU pt's room and rapidly pushing D50 and insulin because their K+ is 7.0, certainly the pt or family is going to ask 'what's up?'. Yeah, I'd tell them that their potassium is pretty high.

[MunoRN, RN]

Not sure where the idea came from that HIPAA prevents you from telling the patient results of labs and tests since HIPAA actually specifies that patients have the right to know what's in their chart. In terms of other laws, Labs, imaging centers, and other third party services are often not allowed to release results, although Nurses are not thirty party service providers.

It's also part of my state's Standards of Practice for Nurses. As part of our role as patient advocates, we're required to keep the patient informed about their status and progress of their care. This doesn't mean guessing at diagnoses when results that need interpreting have not yet been interpreted, but informing the patient of an already interpreted test result is not diagnosing. Nor is telling the patient a lab result. This may require some education about the lab and the result, but that's our job.

I'm still not really clear why some Nurses would withhold information, that seems counter-intuitive to the basic concepts of Nursing. Some mentioned they would only tell a patient lab results that they would already understand such as the INR of someone who's already been on coumadin, is that because you wouldn't have to explain to them what the test and result mean? Otherwise you don't tell them?

Maybe it's a regional Nursing culture thing, but at both facilities where I have worked the Nursing staff keeps patients up to date about their test and lab results, we only bring in the Doc if the patient has questions only the Doc can answer or if the patient requests specifically. Otherwise the patient doesn't get timely or complete information, and we we aren't ensuring that they are getting timely and complete information, then we aren't doing our jobs.

[nurseprnRN, BSN, RN]

"it's also part of my state's standards of practice for nurses. as part of our role as patient advocates, we're required to keep the patient informed about their status and progress of their care. this doesn't mean guessing at diagnoses when results that need interpreting have not yet been interpreted, but informing the patient of an already interpreted test result is not diagnosing. nor is telling the patient a lab result. this may require some education about the lab and the result, but that's our job.

i'm still not really clear why some nurses would withhold information, that seems counter-intuitive to the basic concepts of nursing. some mentioned they would only tell a patient lab results that they would already understand such as the inr of someone who's already been on coumadin, is that because you wouldn't have to explain to them what the test and result mean? otherwise you don't tell them?

maybe it's a regional nursing culture thing, but at both facilities where i have worked the nursing staff keeps patients up to date about their test and lab results, we only bring in the doc if the patient has questions only the doc can answer or if the patient requests specifically. otherwise the patient doesn't get timely or complete information, and we we aren't ensuring that they are getting timely and complete information, then we aren't doing our jobs."

i don't usually quote at such length but this was so perfect i had to repeat it. and highlight it in red, and italicize it.

imnsho the answer to the completely sincere question in the second paragraph above can be found in a lot of the posts on this and many other threads on an. waaaay too many nurses (note: not all) don't really know what the labs mean or how to explain them to patients well enough to discharge their complete duties as registered nurses per the ana scope and standards.

::looking around for the smilie for "putting on my flameproofies"::

[nurseprnRN, BSN, RN]

"as far as the comments about doctors interepreting xrays. they have already done that. radiologists read them and that is a doctors interpretation. the admitting md often doesn't even look at them. i have no qualms sharing that. i will not discuss plan of care but the results are there in black and white. if its complicated i know i won't have the answers to all of the questions i won't divulge but if it's simple, broken arm...pneumonia...kidney stone....i don't have a problem sharing the result. it relieves anxiety to know what is wrong. i would hope a nurse would do that for me instead of making me wait a day to talk to the doctor."

and wouldn't you rather have the patient/family think that everyone who's part of the treatment team knows and understands what's going on? or would you prefer to support that discredited old trope of "the physician is the captain of the ship" by deferring any such discussion, giving the impression that's because you're "not qualified"?

someone also said s/he looked in the bon info for support on this concept. you need to look more closely: almost every state in the union models its nurse practice act after the ana scope and standards of practice, in many cases lifting big hunks of it verbatim. you can get the s&sop for short money at most booksellers for like $20 and it's a good read.

and for the student who thinks the standards of nursing care are different in a hospital-- you're right, you're in no position to have known better, so you get a bye on this. but just so you know... that's incorrect, and you will learn that by the time you graduate. i hope.

[Esme12, ASN, BSN, RN]

To give an example of when I didn't say something...

Had a patient come up with AMS and suspected TIA with progress notes indicating resolved symptoms. My assessment was a bit different, and the admitting doc ordered a stat CT. The daughter was concerned that her dad was being taken so quickly for the CT. Reading came back as acute infarct, but it was too late from onset of symptoms to start fibrinolytics and ASA had already been given in the ER, so my post-CT orders were fairly routine. When asked about the results, I punted to the doctor. Not sure if that was right or wrong, but that was the only response I felt comfortable with.

That's when I get the family on the phone.....let the MD talk with them. Although in todays worls cal the hospitalist.

[dudette10, MSN, RN]

That's when I get the family on the phone.....let the MD talk with them. Although in todays worls cal the hospitalist.

You're absolutely right. When I got the doc on the phone to read the results and get orders, I should have asked him to speak with the bedside family right then and there. I didn't think about it (I was still in orientation and feeling shaky), but from now on, I certainly will. Thank you.

[lyndasue]

What if you are a home health nurse & you have notified the MD about lab results.......do you keep calling until the MD tells you what he/she plans to do? :bang_head:

[hiddencatRN, BSN, 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. :)

I agree that it depends. We see patients with sickle cell and they often want to know what their "numbers" are after we draw labs, for example. I don't hide the accucheck screen from my diabetics either.

And if I'm doing something like a rapid strep test, I'll share the result with the family.

But honestly, I'm not that great at interpreting lab results yet, so I often will say "the doctor will be in to discuss the results once s/he has had a chance to review them."

[Anna Flaxis, BSN, RN]

As far as the comments about doctors interepreting xrays. They have already done that. Radiologists read them and that is a doctors interpretation. The admitting MD often doesn't even look at them. I have no qualms sharing that. I will not discuss plan of care but the results are there in black and white. If its complicated I know I won't have the answers to all of the questions I won't divulge but if it's simple, broken arm...pneumonia...kidney stone....I don't have a problem sharing the result. It relieves anxiety to know what is wrong. I would hope a nurse would do that for me instead of making me wait a day to talk to the doctor.

In my practice we always get imaging results long before the radiologist's dictation is posted. That means I can look at an xray, ultrasound, or CT, but I can't see the radiologist's interpretation, because it hasn't been posted yet.

Not all fractures are obvious, and I'd sure hate to tell someone they didn't have one when they really did. I can tell if someone has COPD or blunted costophrenic angles, or a hemo/pneumo, but I sure can't tell perihilar densities from focal consolidation or pulmonary vascular congestion. I can see a skull fracture or a subdural bleed on a head CT, but I have no idea what microvascular ischemic changes look like.

By the time the radiologist's dictation is posted, the ordering physician has already seen the imaging study and has been called by the radiologist with the results. There is no waiting a day to talk to the doctor, maybe thirty minutes or until the doctor is finished intubating or suturing another patient, but I hardly think it's a crime worthy of anyone's wrath to make the patient wait thirty minutes for the doctor to give them their diagnosis.

Clearly, any time I am administering a medication or sending a patient for a diagnostic, I understand the WHY of it, and would never lie or play dumb. I explain the rationale for all that I do. But it is not my role to look at a lab result or an x ray and make the decision whether to administer Lasix or Levaquin. That is the doctor's job, and it is also the doctor's job to go in the room and tell the patient what the plan is and why. My job is to fill in the gaps *after* the doctor has given the patient their diagnosis.

For a doctor do a "drive by"- look at an xray and order some antibiotics and never even lay eyes on the patient, let alone go into the room and explain the diagnosis and treatment plan- is bad *medical* practice.

The exception would be for a critical lab result, like a critically high K+ for instance. I might call the physician with the result and get orders and implement them before the physician can pull themselves away from whatever they are in the midst of. In that instance, I would be telling the patient that their potassium is high and that I am going to give them medications to reduce it prior to the physician coming in to speak with them.

[celticwonder99]

Greetings:

It is actually just a wee bit more complex than personal choice; Most licensing bodies for nurses in Canada and the US outline 'competencies' that delineate scope of practice, but not specifics in terms of lab results.

In all provinces in Canada, a nurse cannot provide clients the results of lab test because it may confer a diagnosis....which is beyond the scope of our practice and license. If a client has been given a differential diagnosis and their MRI is normal....this 'normal' result for X may confer a diagnosis of Y.

Unfortunately, even something as seemingly simple as relaying abnormal pap smear results in primary care MUST be done by the client's primary provider so that the results can be given in the context of a discussion about treatment options WITH THE PHYSICIAN, Nurse Practitioner or Physician Assistant!

Check with your local/state/provincial college of nurses before you utter a word!

Cheers everyone..hope this was helpful!

Donna

[canoehead, BSN, RN]

Labs have ranges of normal, and Xrays have written impressions, so if they come back normal I say "the lab/radiologist report the results as normal." If I've just done a 12 lead I say "I don't see anything life threatening, but the doctor has to look at it for the final read."

Abnormal results I'd report them as abnormal, and say "this sometimes indicates x, y, z, but the doctor will talk to you about it." Or "I see abnormalities in the results, but I don't have the background to interpret it for you. The doc will be in, but in the meantime we'll do x, y, z to bring you back to a normal level/or find out why there's a problem."

I've had to emphasize that I don't have the knowledge to answer them, even after test results are back, sometimes. I want them to have good solid information, not waste time and worry on guesses, so I'll make sure the doc knows they want to talk to him, and I'll keep them as informed as possible until then. Worst of all is someone coming into the ER with vague symptoms, and tests come back with a devastating diagnosis. I say, "There's definitely something wrong, but you knew that already. I don't have the knowledge to give you a clear picture, but your physician does," and "Even to my eye there was a problem (re Xrays/CTs) but I don't know enough to diagnose or explain it." I won't lie, and I don't want to minimize the problem. I think letting people know they are going to get some bad news lets them prepare mentally, and maybe call in some supporters. I'm lucky, being in the ER the doc is just tied up elsewhere and will be along soon. If we were talking days of holding back as a floor nurse...I'd probably advise family to request a second opinion or a copy of the chart if they aren't getting the full picture.