Feature Story

Some physicians are inconsistent in notifying patients about abnormal test results

A new study shows that over one-third (36 percent) of physicians do not always notify patients of abnormal test results, especially when the patient is expected back shortly for a followup visit. Physicians commonly lack methods to ensure that they receive the results of tests ordered for their patients, depend on followup visits to communicate results to patients, and don't document reporting test results to patients. This lack of followup can have a negative effect on patient care and may increase the risk of malpractice suits, conclude researchers supported by the Agency for Health Care Policy and Research (HS07516).

Bruce D. McCarthy, M.D., M.P.H., of Henry Ford Hospital, and his colleagues surveyed 207 attending physicians and residents in family practice and internal medicine at a large urban teaching hospital and 21 suburban primary care practices in Southeastern Michigan. Reasons cited by physicians for not reporting abnormal results were that the results were trivial, the patient was expected to return to the clinic soon, and in a few cases, the patient could not be reached, they forgot, or did not have enough time.

Only 28 percent of physicians always notified patients of normal test results; the remaining 72 percent left patients to assume that "no news is good news." However, abnormal test results may never reach the physician or fall through the cracks if a system is not in place to ensure that test results are received by the doctor. Such mistakes leave the patient falsely reassured when they do not hear from the doctor.

Only half (55 percent) of physicians always made an entry in the record when they notified a patient about test results, 30 percent did so most of the time, 12 percent in some cases, and 3 percent of physicians never did. About 77 percent of physicians had no reliable method to identify patients overdue for recommended followup testing, such as Pap smears and mammograms. There is disagreement about whether it is the physician's duty or the patient's responsibility to ensure followup; to some extent, this depends on the significance of the abnormalities found, conclude the researchers.

For more information, see "Patient notification and follow-up of abnormal test results," by Emily A. Boohaker, M.D., Richard E. Ward, M.D., M.B.A., Jane E. Uman, M.P.H., and Dr. McCarthy, in the February 12, 1996, Archives of Internal Medicine 156, pp. 327-331.

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