FW: [IMPROVEDX] Positive tests

Vic Nicholls nichollsvi2 at GMAIL.COM
Tue Mar 10 02:28:15 UTC 2015


Excellent point.

One item: are the lab results normal *for the patient* over time even
though they are "normal" by the computer? My serum Ca used to be in the
8's. Now it is in the middle 9's, still normal but not normal for me.
Checked the kidneys w/urine tests. 3's and then 2's Ca level, not a
typo. Dexa scan showed what we figured out.

I've been on meds for a while, consider what would have happened with a
high risk family history and someone just going by the computer saying
all is well?

Vic

On 3/9/2015 4:49 PM, Timothy Stevenson wrote:
>
> It is interesting, and yet a little disconcerting, to see the
> variation in perception as to how important and/or necessary it is to
> provide the patient with results from tests ordered that are “good
> news”. From the patient’s perspective, “no news” does not necessarily
> mean “good news”. Rather, it means “What did the tests show?” anxiety.
> Remember that the patient came to see you because “something was
> wrong”. The fact that the test comes back with a “There is nothing
> wrong” result does not answer the question the patient originally came
> with. As a Quality Assurance officer I regularly talk to patients who
> either have not heard the results of any tests they were sent for,
> have not had the results of the tests clearly explained to them or
> have been told “the tests show nothing is wrong”. Their original
> question of “what is wrong with me” or “what is causing me to feel
> like this” remains unanswered.
>
> Perhaps we need to go back to the original discussion with the patient
> where *_informed consent_* was obtained to undertake/ refer for the
> test. Receiving the results with an explanation as to what they show
> or don’t show must be a part of the overall process. I would disagree
> that simply sending the results to the patient in the mails is
> adequate. I have been handed copies of my blood test results with
> “These show everything is alright”, only to see **hi** and **lo** next
> to some results. If the LAB flags these areas, then these results are
> “not okay”.
>
> I appreciate that explaining all results will put extra strain on the
> already busy medical practitioners, but perhaps testing will become
> more targeted.
>
> Tim
>
> *Timothy Stevenson*
>
> Quality & Safety Manager | *SWSLHD Community Health*
>
> Executive Unit, 1 Bolger Street, Campbelltown, NSW 2560
> Tel (02) 4621 8767 | Fax (02) 4621 8775 | Mob 0455 075 055 |
> timothy.stevenson at sswahs.nsw.gov.au
> <mailto:timothy.stevenson at sswahs.nsw.gov.au>
> http://www.swslhd.nsw.gov.au/CommunityHealth/
> <http://http/www.swslhd.nsw.gov.au/CommunityHealth/>
>
>
> Description:
> http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-South-Western-Sydney-LHD.jpg
>
> *From:*Maureen Cahill [mailto:MCahill at NCSBN.ORG]
> *Sent:* Tuesday, 10 March 2015 6:48 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Positive tests
>
> Would it be possible to negotiate with a practice’s  laboratory
> provider that at a minimum all results are mailed and then abnormal
> results could have an additional faster track notification?
>
> Maureen
>
> Maureen Cahill [Associate] 312.525.3646 (D) mcahill at ncsbn.org
> <mailto:mcahill at ncsbn.org>
>
> National Council of State Boards of Nursing (NCSBN) 111 E. Wacker
> Drive, Ste 2900, Chicago, IL 60601-4277 312.279.1032 (F) www.ncsbn.org
> <http://www.ncsbn.org>
>
> Our Mission – NCSBN, Leading in nursing regulation
>
> *From:*Avrum H. Golub, M.D., J.D. [mailto:avrum_h_golub_md_jd at ME.COM]
> *Sent:* Monday, March 9, 2015 11:14 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Positive tests
>
> Lest we forget, patients are people and physicians may be patients.
>
> Please consider the “Golden Rule” and good manners.
>
> And, of course, the reassurance to a patient that we can convey.
>
> If not the physician, perhaps the ministering angel of the bedside
> (nurse) or another physician extender who has empathy and compassion.
>
> Some of the incomprehensible telephone reports (or not report) that I,
> as a patient, have received from physicians’ staffs are rude and
> anxiety provoking, at least.
>
> I am a Pathologist.
>
> Avrum H. Golub, M.D., J.D.
>
>     On Mar 8, 2015, at 8:10 PM, Pauker, Stephen
>     <SPauker at TUFTSMEDICALCENTER.ORG
>     <mailto:SPauker at TUFTSMEDICALCENTER.ORG>> wrote:
>
>     In my experience and writings , negative or normal test results
>     can be quite important in making a diagnosis, so not communicating
>     them to the patient can be withholding key information. All
>     results positive or negative should be communicated. Further
>     withholding them can sometimes lead to repeating the test
>
>     Steve
>
>
>
>     Sent with Good (www.good.com <http://www.good.com>)
>
>
>     -----Original Message-----
>     *From: *Robert Bell [rmsbell at ESEDONA.NET <mailto:rmsbell at ESEDONA.NET>]
>     *Sent: *Sunday, March 08, 2015 01:33 PM Eastern Standard Time
>     *To: *IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>     <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>     *Subject: *[IMPROVEDX] Positive tests
>
>     Many doctor's offices only call or mention to patients positive
>     test results that have been undertaken (particularly lab tests).
>     Is that a good thing and does it in any way impact diagnosis?
>
>     Also, what are the effects of the new electronic portals on
>     diagnosis. It is a big change in medicine.
>
>     Rob Bell
>
>     Sent from my iPad
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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