For patients, what’s the worst-case scenario when it comes to imaging tests?

Marianne Matthews

My friend is your worst nightmare. She’s perky, intelligent, and highly efficient. And here’s the deal: She expects you, your staff, and the referring physicians she sees and you work with to be extremely efficient, too.

Picture the scenario: She comes to your practice or imaging center for an ultrasound, mammogram, or MRI. Three hours later, she calls your office: Can you tell me the results? But the results are not yet in. The next morning, she dials you up again: So how does my test look? You’re not quite ready to give her your read. Five hours go by, and the phone rings again. This time her tone is downright bellicose. …,Well, you get the idea. She’s the patient, but she’s also a nag.

When it comes to test results, patients can be quite impatient. And as it turns out, that’s probably not such a bad thing.

According to a recent report in The New York Times (June 23, 2009), “Researchers studying office procedures among primary care physicians found evidence that more than 7 percent of clinically significant findings were never reported to the patient.”

Associate professor Lawrence P. Casalino, MD, PhD, at Weill Cornell Medical College led the team of investigators who reviewed the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers. According to The Times report, they pulled records that contained “abnormal results for blood tests or X-rays and other imaging studies, and then searched for documentation that the patient had been properly informed of the problem in a timely way.”

The upshot: Out of 1,889 abnormal results, the researchers found 135 failures to inform the patient.

So for patients, no news is not necessarily good news. The study indicates that patients need to demand those results when their doctor does not call. It’s just plain practical for a patient to be a nag … or at least, a nudge.

But the study raises a critical question: Why would a physician’s office fail to inform a patient with abnormal findings?

Simply put, information slips through the cracks. According to The Times reporter, practices that used electronic medical records had lower failure rates than those that used only paper documents.” But offices that used a combination of paper and computer records had the worst results of all.” (To learn more about electronic medical records, see “Meaningful Search” from our archives, and see our monthly Informatics section in this publication.)

For patients, not getting test results is only one frustrating scenario. Here’s the really nagging question. What’s worse: Not getting your test results or not having access to an important test in the first place?

That’s the case when it comes to virtual colonoscopy, for example. CMS recently made a decision not to cover CT colonography. Yet more than 140,000 Americans are diagnosed with colorectal cancer every year, and nearly 50,000 die because their cancer is detected too late. Experts say if virtual colonoscopy were covered, more patients would go for the exam—and lives would be saved—because it is less invasive than traditional colonoscopy. (To learn more, see “Virtual Standstill” in this issue. Or listen to our Podcast series.)

I’m a patient, but I’m not patient. I want access to every imaging test—in the event that I need it. And I want my test results—right away. Are you prepared for people like me?

Marianne Matthews