Many people are perfectly satisfied with having their doctor communicate the results of medical tests and explain what they mean. Others want the results, like, right now instead of waiting for the information to first be channeled through the doctor.
Which way is best?
Once upon a time, there wasn’t much choice. The way the system worked was that the doctor reviewed the test results first, then shared them with the patient. Now all of this is changing, propelled by a growing desire by many people for direct access to their medical information. It’s being further fueled by a U.S. Department of Health and Human Services proposal to expand direct consumer access to laboratory test results, an option that’s currently only allowed in a handful of states, to all U.S. health consumers.
There’s considerable debate, however, over whether this is good or bad, and how the disclosure of test results should best be handled.
By all means, give patients access – but there should be guidance by a physician in order to understand what the test results mean, is the position of uberblogger Dr. Kevin Pho, who recently wrote on the subject for USA Today.
Dr. Pho writes:
Patients should have access to their lab tests. But it is crucial that a medical professional explains the results. Raw numbers without the benefit of context can also cause patient anxiety. Some abnormal results are due to chance or lab errors. Other results can be a normal variation for that individual patient. Many lab results are misleading and not indicative of any disease. Patients often assume the worst, so viewing results alone might cause unnecessary alarm.
He has a point. It’s often difficult for the layperson to sort through the numbers and try to figure out which, if any, are significant. People can become upset by what they see, and it isn’t always easy to allay their fears over something that has been misunderstood or misinterpreted.
On the other hand, why not give patients some credit for being able to comprehend their test results and deal with whatever the emotional fallout might be?
Barbara Bronson Gray, a registered nurse who blogs at BodBoss, holds the latter view. In a recent blog entry, she demolishes all the reasons physicians often give in favor of maintaining the status quo.
Patients might become unduly anxious by their test results. “We’re grown ups. We deal with good and not-so-good information all the time. No one holds my hand when I see what happened to the stock market on a given day.”
Patients won’t understand the results. “Try me. If I don’t understand, I won’t freak out. I’ll just do some research or ask you.”
Patients will take up too much of the doctor’s time asking questions about their lab results. “It doesn’t really take very long to explain what these things mean.”
The debate over direct and immediate access to lab results is an echo of an even larger conversation about access to the complete medical record. It’s a power struggle over information – who has it, who controls it, who decides.
Health care practitioners are being forced to rethink how they’ve traditionally regarded the patient’s medical information. Simply communicating to someone that their test results are “normal” doesn’t (and shouldn’t) really cut it anymore. And given the amount of health information available online these days and people’s willingness to pursue it, the assertion that patients don’t have what it takes to understand their test results is beginning to ring rather hollow.
From the clinician’s point of view, there may be problems and nuances about giving people direct access to their test results – logistics, for instance, or timing – that make this somewhat more complicated than a straightforward case of “gimme my results.” There’s a fine line, however, between honest concern over whether the public is ready for this and plain old-fashioned paternalism. The real question seems to be where that line should be drawn.
What do readers think? Do you want direct, immediate access to your test results or would you rather receive them from the doctor?