Another argument for patient's access to their test results

Luke Perkocha luke3580 at GMAIL.COM
Mon Apr 21 14:31:26 UTC 2014


Dear Mark and All,

No question a disturbing story.  However, on the topic of releasing test
results directly to patients, there has been some recent legislation /CMS
rulemaking on this topic as some may know, making it mandatory for clinical
laboratories to release test results to patients within 30 days of the
patient's request.  For some time, many of  us in the clnical lab community
have been in favor of this as a patient safety tool to reduce the
impact/incidence of critical test results "falling  through the cracks"
since failure to follow-up is so often a cause of harm and subsequent
malpractice litigation. A step forward, but the new rules do not require
results to be "pushed" to patients, only made available on request. I
believe Palo Alto Medical Founation and Kaiser Permanente have been early
adopters of the policy to proactively release results to patients.  However
the devil is always in the details: certain test results have been "exempt"
from this policy on the thought that the release to the patient without
accompanying medical explanation by their provider might be harmful (HIV
and PSA for example - ironically both potentially actionable and
consequential if missed). In addition, a much harder area is that of
pathology results and radiology results, where the "result" is often not a
binary "normal" or "abnormal" but sometimes a "not sure, but this is the
recommended follow-up."  Moreover, some results in pathology, for instance,
like "cancer" need further explanation, since the very word may mean a
death sentence to a patient, while it may actually be a trivial curable
disease (non-melanoma skin or others) or chronic manageable condition
highly unlikely to kill the patient or have significant morbidity - it is
much harder to ferret out a policy around direct release of results to
patients in these areas. One other interesting approach is that some
laboratories have developed an information system approach to direct
patient reporting - I know of one lab that encourages physicians to give
the laboratory's cervical cytology automated result phone number directly
to the patient and instruct them to call for results - in the case of a pap
smear, if the result is normal, the patient is told; if abnormal, they are
instructed to contact their physician's office for further instructions.
Thanks for passing on news of this incident and the issues it raises.

Luke Perkocha, MD, MBA
Department of Pathology
Kaiser Permanente, Northern California
luke.perkocha at kp.org


On Sun, Apr 20, 2014 at 8:02 PM, Graber, Mark <Mark.Graber at va.gov> wrote:

> In a very disturbing story this week, a radiology tech was accused of
> notifying 1000+ women that their mammagrams were normal, although she
> didn't know this to be true, and some in fact were not.
> http://www.today.com/video/today/54989210#54989210
>
> Its my understanding that all women are supposed to receive a copy of
> their test result, and its not exactly clear from this report if the tech
> just gave women a verbal 'ok', or if she actually altered the radiologist's
> report.  This is a class of diagnostic error I've never encountered before,
> but I'm hoping that the directly-mailed results mitigated the tech's false
> assurances.  If anyone has access to more facts on this case, I'd be
> interested to hear them.
>
>
> Mark L Graber, MD FACP
> Senior Fellow, RTI International
> Professor Emeritus, SUNY Stony Brook School of Medicine
> Founder and President, Society to Improve Diagnosis in Medicine
> MARK.GRABER at IMPROVEDIAGNOSIS.ORG
>
>
>
>
>
>
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
> for Improving Diagnosis in Medicine
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