FW: [IMPROVEDX] Positive tests

Victoria Nicholls nichollsvi2 at GMAIL.COM
Tue Mar 10 11:53:15 UTC 2015


 Right!

This is where I want to see patients doing more of this type of work.
I believe there are things the patient can do that help docs, and
things docs can do to help us work together to improve communication,
improve diagnoses, cut out fluff in medicine so that costs are lower
and care is more targeted and right. I don't think there is any
patient or doc who chooses lawsuits over getting appropriate care.

Except for the lawyers and admin.

On Tue, Mar 10, 2015 at 6:25 AM, Sherri Loeb <sherriloeb at gmail.com> wrote:
> Very true about normal according to computer. We need to watch trends not
> just normal values. What's normal for one person may not be for someone else
> if you are trending up or in the case of a PSA a sudden doubling even within
> normal range.
>
> Sent from my iPhone
>
> On Mar 9, 2015, at 9:28 PM, Vic Nicholls <nichollsvi2 at GMAIL.COM> wrote:
>
> 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
> http://www.swslhd.nsw.gov.au/CommunityHealth/
>
>
> <mime-attachment.png>
>
>
>
> 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
>
> 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
>
> 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>
> 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)
>
>
> -----Original Message-----
> From: Robert Bell [rmsbell at ESEDONA.NET]
> Sent: Sunday, March 08, 2015 01:33 PM Eastern Standard Time
> To: 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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