Tuesday, September 6, 2011

“Please Give Me My Test Results (Not Just An Interpretation)”

As of 2010 I had had six doctors in six years.  Only one of those changes was my idea; here’s how it went:

1.   My doctor of 25 years retired, driven out by increasing costs for liability insurance.
2.  Doctor got a job with a corporate clinic. 
3.  Doctor got a job with the VA.  I’m not a vet.
4.  Doctor seemed to have an anger management problem.  I moved on to
5.  A great guy, but he became the hospitalist with the affiliated hospital.
6Wonderful new doctor – hope she stays around.

I’m sure my experience is not unusual and it illustrates an important point: most doctors today don’t know their patients well. 

In the TV show “House” doctors read the patient’s whole chart and sometimes even personally check their home for toxins or microbes.  In the real world none of this happens.  Medical staff rarely have time to read much of the patient’s chart.  The last time I went in for a physical the first nurse I saw asked me when I had had my last period.  I am 65 and I had a hysterectomy at 32!

Doctors who don’t know you well and don’t read much of your chart are forced to rely on test results because, apart from what they can glean in a short visit, this is all they have.  There are some problems with this approach.  First, mistakes happen.  After getting an unexpected result on a cholesterol test I asked about it and learned that the lab had misapplied the formula for calculating LDL.  A friend of mine was told, incorrectly as it turned out, that he was diabetic because of a lab error.  In such cases procedures or medication may be prescribed when they are not needed. 

Second, when interpreting test results it is important to consider the context.  Each person’s body is unique and some have idiosyncratic test results that are normal for them.  Without reading the patient’s chart in detail the doctor may not know this.  In my case the white blood cell count is sometimes low.  Doctors are concerned about this because it can indicate the presence of illness, including some serious conditions like cancer.  One of my doctors ordered a re-test and it was normal.  Without any other indications that I am ill I am going to forego any WBC re-tests in the future.

Third, having actual test results can give the patient important insights into how his or her own body is functioning.  For much of my life I have had weak muscles.  At some point I looked at my blood test results and noticed that my protein was a bit low.  My doctor was not concerned about this because at that level it was not a predictor of illness but I decided to start taking a protein supplement to get my reading up into the normal range.

Fourth, and most important, sharing actual test results promotes reciprocity and team work between doctor and patient.  It encourages the patient to be an active participant in his or her own care instead of giving all the responsibility to the doctor.  Research has shown that patients who are informed and participate in their own care have better outcomes.  So please, please give me a copy of my test results.  

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