Published Jul 1, 2009
I had a patient who had a HIDA Scan. Obviously, I knew the results, and the doctor knew them but didn't come in to the hospital to discuss with the patient the fact that he would need surgery because it was a Sunday night. Meanwhile, the patient wants to know what happened with the test. The patient knew what they were looking for, the diagnosis wasn't a surprise, but the patient still had no formal confirmation.
Do you tell the patient, knowing he is going for surgery the next day and won't be seeing the doctor? Or not? And if not, how do you tell the patient that the doctor is supposed to discuss test results? When I tried this, my patient assumed there must be a tumor that I didn't want to tell him about. haha
I try to avoid discussing results because to me, it can open a whole can of worms. I understand your dilemma, though, because the patient should know what is happening if he is about to have surgery in a few hours.
ohmeowzer RN, RN
i tell them , i cannot give test results because i cannot interpet them , only the docs can do that.
It drives me nuts when I can't get a copy of my test results, and I usually go to another practice. Not really the same as the above, but similar. I don't understand what the big secret is about lab results.
ChristineN, BSN, RN
Well if it's a diagnostic test, I generally won't give them the results. If it is a lab value that the patient is aware we've been watching, I will let them know if it's going up/down, and try to explain. For example, last week I had a newly diagnosed leukemia patient. The patient knew we were watching his white count and CBC. I had no hesitancy telling the family the WBC for the day, or explaining to them how we calculate an ANC.
Virgo_RN, BSN, RN
I had a patient who had a HIDA Scan. Obviously, I knew the results, and the doctor knew them but didn't come in to the hospital to discuss with the patient the fact that he would need surgery because it was a Sunday night. Meanwhile, the patient wants to know what happened with the test. The patient knew what they were looking for, the diagnosis wasn't a surprise, but the patient still had no formal confirmation.Do you tell the patient, knowing he is going for surgery the next day and won't be seeing the doctor? Or not? And if not, how do you tell the patient that the doctor is supposed to discuss test results? When I tried this, my patient assumed there must be a tumor that I didn't want to tell him about. haha
Heck no, I do not tell the patient! That is the doctor's job, and that is what I tell the patient.
Now, as mentioned, if it's a lab result that the patient is already educated on, such as the INR for someone on Coumadin, I think it's okay.
It is not in a nurse's scope of practice to tell a patient test results, and that's what I say when there is a problem or I see that withholding a negative test (no problem) is causing the patient no undue stress. However, if its like a chest xray and shows nothing different or abnormal, and the patient is on the side of the bed hyperventilating thinking a tumor showed up because I won't tell them, I will say something. Usually something like "although I can't discuss the results of it, I would not be worried about this particular test result if I had the same test and got that result" wink wink.
if a pt is really anxious about test results and md not available, i will try to get another doc to talk to pt.
this is only when i feel pt needs to know sooner vs later.
wooh, BSN, RN
In that situation, I'd call the MD, tell them the patient is worried about the result, and offer to transfer the call into the room so the MD can talk to the patient on the phone. Normally at my facility that's not a problem (we've got a good set of docs that normally will make sure that they've talked to patients about important results anyway.)
I had several situations that were sticky in the past. On Wednesdays, we have no morning clinic, but we see walk ins for PPD readings, tubal ligation counseling, shots, etc... and then, there are those that are responding to letters regarding abnormal test results. A patient came and showed me a letter informing her of a negative result. No doctors were around or responding (they are usually in conference-translation-not making themselves available when we page). I saw that the patient tested positive for chlamydia and noted that a prescription was left for us to administer Zithromax. The patient was very upset, not knowing and when I took it to the RN, she told me she'd explain to the patient and I give the drug. I was not comfortable with this.
Just today, a patient came in responding to a letter received. She didn't have the letter on her, but she stated that it said she had abnormal results and wanted to know what it was. I looked in the computer and saw slightly abnormal thyroid labs. I also noted that her first and only visit to the clinic was in May, the doctor ordered that she return in one week and she was a no show, and also that she is 26 weeks, now. They didn't seem extreme to me, but, for one, as an LPN, it is certainly not my position to interpet results. Called the RN in, and she tells the patient that she sees abnormal thyroid results (I would not have even said that, really), and suddenly, the patient starts crying and thinking that she will die because she doesn't know what a thyroid is. I did explain the function of the thyroid, and told her I would speak to a doctor. Took it to the attending and he saw no reason for this patient to get a letter, either, but, he tells me to tell the patient that everything is okay and to schedule her to return to the clinic in a week. I felt he should explain this to her, and told him so, but he 'has no time'. When I get back to my room, the patient is gone, I don't know where she is. I page her and she returns with the social worker crying. I repeated what the doctor said and scheduled an appointment for next week, telling her of the importance of returning for prenatal care. And, told her that if she ever receives a letter from our clinic, to bring it with her so that we can better answer her questions.
I suspect that someone sent her a letter to reschedule, and maybe they sent the wrong one, but it was dicey to me, because under those circumstances, a physician should be the one to speak to the patient first. I can tell whether or not a lab is abnormal, but, I am not a doctor and cannot interpet what this particular reading would mean for a patient's total condition. Too dicey...
nerdtonurse?, BSN, RN
My stock answer (especially if it's BAD) -- "Ma'am, I'm sorry, those labs aren't back yet. It's not uncommon for those particular labs to take several days to result, although they would call us if they saw something imminently dangerous."
If the patient is really freaking out and the result is good (like the summary on the CT saying "no malignancy indicated, normal thoracic CT") then I tell them that while all the results aren't back yet, I haven't seen anything come in that I need to alert the doc about. Usually, that and a xanax are enough....
chenoaspirit, ASN, RN
There were a few rare instances that a patient would become irate with any explanation I could give, even telling them that the result is not back. So, rarely, I would take the patient's chart to them and allow them to review it, but I also told them that I could not interpret anything that they see/read. I was told by managment that I am not allowed to deny any patient access to their chart. If I were in the hospital, I would want to know everything about my body and my health. And I feel I should have the right to know.
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