The Archives of Internal Medicine, June 22, 2009, published results of a retrospective medical record review involving nineteen community based and four academic medical center primary care practices. The researchers were intent upon examining how frequently patients were not informed of clinically significant abnormal outpatient test results. The researcher’s conclusion was that it is common for patients to be uninformed of significant abnormal outpatient test results and they suggest a simple process currently not being followed by most primary caregivers to correct what the researchers see as a problem.
Remarkably, they fail to comment on an additional meaningful conclusion that can be arrived at from examining the same data. The doctors who didn’t inform their patients must not have done anything about the abnormal lab results. Surely, it is not possible that physicians failed to inform patients of significant abnormal lab results only in cases where the lab results, though abnormal, suggested no need for a different course of medical treatment. Perhaps a more important issue for these researchers to have examined is whether the results were communicated to the doctor and whether the doctor incorporated those results in the formulation of each patient’s continued and future course of care.
In these circumstances, a patient’s safeguard of last resort is their own interest in their medical care. Patients need to be attentive not just in the outpatient setting but also in the hospital setting. A patient should not assume that because there are a number of people who seem involved in their care, doctors, nurses, etc., that someone in fact is aware of all clinical events and test results and is thoughtfully guiding the patient’s care with a professional interest in the best possible outcome.
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