Docs Don't Tell 7% of Patients About Abnormal Tests

"Diagnostic errors are the most frequent cause of malpractice claims in the United States," the authors wrote, adding that, "Failures to inform patients of abnormal results and failures to document that patients have been informed are common, and legally indefensible factors in malpractice claims."

One finding from this report that was astonishing is the high number of practices that the researchers said had no explicit rules for managing test results. "In most cases each physician devised his or her own method. In 8 practices, patients were told that 'no news is good news.' i.e. they should assume their results were normal."

The report said there are no generally agreed-upon guidelines to delineate practices to manage test results so that patients are always told. But, they said, these five rules might be used:

• All results are routed to the responsible physician
• The physician signs off on all results
• The practice informs patients of all results, normal and abnormal
• The practice documents that the patient has been informed
• Patients are told to call after a certain time interval if they have not been notified of their results.

The patient was counted as having been informed based on 13 types of evidence, such as a referral for a follow-up test. Additionally, the patient was informed if the physician responded to a subsequent questionnaire indicating the patient had been informed.

One might suggest that in some cases, such as patients who are too old and sick and perhaps unable to comprehend their results, the physician may have no need to tell the patient of a particular finding when more serious medical issues are present. However, the researchers got around that by including younger people below age 70 without existing known chronic diseases.

The researchers noted that while it is possible their report failed to recognize documentation that patients were informed, they added that this group of physicians volunteered for the study. A more random sample might find even greater failure rates.

The researchers also noted the lack of any incentive for physicians to notify patients about test results. "Failures to inform could be approached as a systems problem—a problem of organization and incentives—rather than as a failing of individual physicians," they wrote. In some practices the only way to see a test result is to search through every patient's records. In others, an electronic medical record routes test results to the responsible physician, and the system records the fact that the physician clicked on the results.

The authors summed up: "One approach to reducing failure rates would be to rely on the efforts of individual physicians and to exhort them to try harder to notify patients."

The report was funded by the California Healthcare Foundation.