Know of someone who had a major cancer diagnosis pending. After the needed screening test was performed, communication problems between testing hospital and reporting Dr’s office delayed doctor’s receipt of report. Worried patient spent a few days trying to connect the dots. Admin answering the phone at test center felt badly and told patient that all looked well in the report, risking her job and simultaneously reassuring the patient as the findings were not ambiguous.
I have huge empathy for the demands on health care providers, yet sometimes a lot is hanging in the balance with these tests and the patient is stuck due to systems problems that have nothing to do with Dr’s time or schedule. Perhaps more attention needs to be paid to how these events unfold step by step, so there is a clearcut, generally functional routine and everyone knows what to expect. Results traveling between diverse systems seem most challenging and maybe flagging them would help.
A few things: almost every medical group nowadays is using an electronic health record and the group is subject to Obamacare rules. Those rules require a patient portal on which labs and some tests are viewable by patients. Typically they are viewable to the patient as soon as they are viewable to the doctor. Sometimes the portal is not well utilized - there are other rules (and penalties) governing the “meaningful use” of the portal. If your doctor/medical group has a portal than you do not need to wait. As I recall, the OP was wanting biopsy results. The biopsy results are not finished until the doctor signs off on them. For example, if a dermatology biopsy is sent to path, the dermatologist does not simply accept the result. He interprets it in some form, signs off on it, and that is when it is finished. Biopsy results are unlikely to be available on a portal.
In our group the practice standard for lab/test turnaround is 24 hours from the time the test results are available to the physician (i.e. not from the time the test was performed). So if you are waiting “weeks” as you said than maybe you need a different practitioner.
As to who owns the medical record: you are delusional if you think you own your own medical records. The doctor does not own them (and could be fired/punished for mishandling records) either. The government and the insurance companies own the records - that is the driving force for computerizing them and forcing interoperability among databases. One change that has occurred in the medical records realm as a result of the imposition of electronic health record databases, insurance and government oversight, and many people wanting to read their records is that the records say nothing. Increasingly doctors do not dictate cogent narratives of a patients history, physical, assessment, and plan. Instead they complete a computerized form of deconstructed check boxes and drop down lists and then the computer assembles a “narrative” that is mostly useless. When we get records from outside sources that are printed off of the electronic health record they are sometimes hundreds of pages long. Essentially the record is written in assembly language with zeroes and ones so that the government and insurance companies can data mine until the cows come home. Charging 25 cents per page for copying records can generate more revenue than the actual office visit!
As for getting better service for a dog at the vet’s office - exactly. There is a free market in veterinary care. You pay cash for all services and there are no government cost controls. You probably have excellent access to care with few shortages of veterinarians. In human healthcare, there is somewhat of a free market developing in concierge medicine. If you are the sort who wants instant access to your doctor, rapid turnaround of results, and are willing to pay a market rate, then your problems are solved. However, this model tends to be in large cities where the impact of market interference is the greatest and there is the greatest number of physicians to shrug off the government.
And a large enough number of wealthy patients who are willing to self-pay the costs of their routine medical care and self-insure the risk of the possibility of needing expensive medical care.
@ucbalumnus that is less true now than it used to be. From what i can see (e.g. Consumer Reports) standard concierge medicine costs about $1500 per year which is just $125/month, less than some pay for cell phone service or satellite TV. With annual out of pocket limits on insurance soaring (e.g. $6600 for an individual), the affordability of concierge medicine for the basics is more appealing. Of course, that is because there is still a free market for it. Costs will inevitably go down as doctors flee and patients seek service.
I’ve mentioned this on a previous thread, but it’s worth mentioning again, I think.
Several months ago, I had some gynecological symptoms that led to tests and eventually, to a procedure called a hysteroscopy, which is basically the same as a colonoscopy except that the area being explored is the uterus, not the colon (and there’s no prep!). My symptoms could have been caused by any number of problems, one of which was endometrial cancer.
I had the hysteroscopy and was told that a polyp had been removed and that I would get a call when the biopsy report came in. I was also scheduled for a follow-up visit almost three weeks later.
About a week after the hysteroscopy, I happened to have a routine visit with my primary care provider, who said something like “I’m glad that endometrial biopsy turned out to be benign.” She had received the report but I had not.
I never got a call from the gynecologist’s office. I didn’t officially get the results of the biopsy until my follow-up visit, even though by that point, the results had been available for about two weeks.
I understand that it’s a challenge to interpret test results for patients and communicate with them promptly. But does the medical profession understand the stress that patients go through while waiting for test results? If not for the coincidental visit to my PCP, I would have had to wait at least two weeks longer than necessary to find out that I didn’t have cancer. It’s hard to consider that to be good medical care.
I (and everyone) agree that it is best for patients to get test results as soon as possible. However, the process is like herding cats. Letters require dictation, transcription, mail, correct addresses, time and money. Emails are not HIPIAA compliant. Secure emails are a nuisance. Telephone calls go unanswered or to voice mail. We can’t leave voice mails or messages with non-patients (HIPIAA). Biopsy results are more difficult because they require some processing by the physician. Many doctors who do biopsies also do surgery and they are out of the office and preoccupied for long periods of time. Support staff to assist with reporting results is in short supply due to universal budget cuts. Many health care systems are in a slow to rapid descent financially and rural systems (especially specialists) will be squeezed out into aggregated urban treatment centers.
Medical groups hire lean six sigma tyrants to come in and sort out the workflow messes. It takes them weeks (lean weeks I am sure) of salaried time to hold meetings with those who are not salaried in order to fix a workflow. And then the rules change. All of this to say is that there is layer after layer of hidden tax and regulation that constipates the system. The patient sees a delay in results reporting - that could be a simple oversight by the doctor - but often it is symptomatic of a Soviet style bureaucracy that is just getting started.
So you think as more people leave conventional medicine that the costs of concierge care will fall? That would be good. I’m now on medicare plus supplement with a new provider because my former provider went concierge with a stated price of $4000 per person per year. Our family switched because it didn’t seem that great a deal for a primary care contract. But if he had set the price at half that level, I’d have stayed.
I really know little about concierge medicine. I am sure there is a lot of variation in price and a lot of variation in the level of service provided.
Primary care medicine is dead though. Physicians are being replaced by virtually anyone else as fast as possible and the government controls/limits the number of new family practice residency slots. At some point, if you want to see a physician for primary care, you will be forced to go the concierge route.
We have huge shortages of psychiatrists. A new training program is opening with 3 slots per year for which there are hundreds of applicants. But for many reasons, the class is limited to 3 slots while crisis endures.
The problem with concierge medicine is not the cost of joining. It is that the costs of each individual visit greatly exceed the “usual and customary” rates used by insurance companies. So even if you have insurance that will cover some percentage of out-of-network charges, and that has acceptable out-of-pocket maximums, the costs become untenable very quickly. If your doctor is charging $900 for a visit, and your insurance company is crediting only $150 of that toward your deductible or out of pocket maxes, you will end up paying many times these amounts before getting coverage.
I loved my concierge doctor and loved his network of specialists who provided stellar care and were remarkably responsive. However, as I am not rich, the whole thing was financially untenable.
It’s totally paternalistic and offensive. I’m completely capable of determining the meaning of test results, though I don’t mind also discussing them with a doctor. My body, my tests, my business.
If I need to know what an out of range result means, I’m completely able to find a definitive answer on my own. And boy, call me. Don’t even think about making me come in so you can charge me for a separate office visit and tell me, “Yep, exactly as you can see right here, your X is a point high. That’s statistically irrelevant.” (Yes, I knew this already).
But @TranquilMind as was stated up thread, just because you are capable doesn’t mean all patients are. I’m completely with the medical professionals here who are saying they can’t provide a customized solution for each patient. They just don’t have the time. I think the systems could be improved but if you want that level of service you’re going to have to go the concierge route…
I especially don’t understand the need for the dr. to “interpret” in the case of a CT or MRI, which has been read, and a report written, by a radiologist. D & H have chronic disease involving multiple body organs, and they’ve had lots of tests.
Not once has the PCP/specialist said anything different than what was in the report and actually they give far less information. I’m capable of reading. I understand the concerns posted above by some medical professions, but waiting a week or 10 days AFTER the report is signed and electronically available is not acceptable.
Completely agree that primary care is almost dead, and that’s too bad for someone who is managing multiple health conditions. It’s such a disjointed system prone to issues “falling through the cracks” when there isn’t a general manager.
You have a legal right to your medical records, and doctor’s offices are legally capped at what they can charge you for copying them for you. The government does not own your medical records. Sheesh.
To keep this on-topic, typically the nurse will call me rather than the doctor. I’ve been in the dermatologist’s office when the nurses were doing the call backs for patients whose results had come back with cancer. It was very matter-of-fact: your tests results showed cancer, you need to schedule an appointment as soon as possible to discuss treatment options. boom boom boom, one after the other, cancer cancer cancer.
I never said that you don’t have a right to access records. I said you don’t own them. I found this:
“There is no consensus on who owns medical records. The Health Insurance Portability and Accountability Act (HIPAA) does not specify ownership, and state laws are inconsistent. Only New Hampshire has a law stating that patients own their medical records. In 20 other states, providers own them. The rest of the states have no legislation addressing the matter, according to an analysis of state laws by Health Information & The Law, a project of the George Washington University’s Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation.”
Not sure what they do in NH, but I wonder how much the patient is charged to manage the records he owns? You are naive if you do not think that the government is the final possessor of your records. They can show up on any day at any time and demand to see any records for any patient.
The last few times that I had common blood work, the results were put on the patient web site the same day, along with the physician’s comment that they were fine. This was at a large multi-specialty non-concierge practice.
Granted, a biopsy may be more unusual. But it does seem like the OP’s physician’s practice is not good at customer service or managing patient expectations as to when the physician will have reviewed the lab results and be ready to inform the patient of what they mean.
@VaBluebird , were you quoting someone there? I must have missed that post. While it’s true that it takes a radiologist to read a CT or an MRI, it doesn’t take a radiologist to read that radiologist’s written report. In my experience, those reports are always very clear, even to a non-rocket scientist.
@VaBluebird was quoting me and @alwaysamom is correct with what I meant by the word “read”. It does NOT take a rocket scientist to read the report which the radiologist has written. They are indeed very clearly written, or at least they have always been in our experience.
@VaBluebird was quoting me and @alwaysamom is correct with what I meant by the word “read”. It does NOT take a rocket scientist to read the report which the radiologist has written. They are indeed very clearly written, or at least they have always been in our experience.>>>>>>>>
Ah. Pardon me as I am (was) a healthcare provider and to “read” CT scans or MRIs is into itself a process. Not just to read a report of the results of such.
