This discussion reminds me of my very kind previous physician, who left a message on my phone when I got the abnormal mammogram letter, heading off worry at the pass. Her point was that it was a routine, no reason for concern call back for another scan. She was right. I don’t believe in worry, but in that case, I’d have worried.
She left practice a year or so later, as she felt inadequate in the face of the electronic medical record and the expectation of instant results for all. My next physician left for similar reasons. The pile of lab and other results requiring note and letter generation within 24 hours added greatly to the stress of the job.
For what it’s worth, I’ve read quite a few radiology reports in my day that were as clear as mud. Most of the time they include “must include clinical correlation.” Of course, the brain tends to be muddy. Usually, my patients want to sit down and talk about the reports. I can’t imagine the anxiety if they had to sit with “diffuse hypodensity of the cerebral white matter” or “white matter lesions” prior to meeting. Of course, they could always “Dr. Google” it.
Doctors can be jackasses just like anyone else. But this isn’t evidence of it. Reviewing results prior to releasing them is good, ethical care. The hippocratic oath is first do no harm. While it might be true that some people could handle their results, how in the world would you expect the physician to know this beforehand.
Many of you report being anxious not knowing your results. You do realize there are people who are not like you and are more anxious having that information without talking with the doctor? So if you want your doctor to be a mind reader and know what you can handle OR provide that top level of service, I recommend concierge care.
I think it is a pretty good indication that the patient would like to review the report without speaking to the doctor when the patient is standing in the office saying, “I would like to review the report without speaking to the doctor.” That’s situation I was in when my request was denied. It doesn’t take mind-reading!
Imagine someone showing up at your workplace without an appointment and demanding to see your unfinished work on the spot. And then being indignant about it. Perhaps you could consume several hours of a patient advocate’s time? Imagine having about 1600 you’s as patients. I agree that you had to wait too long for the results (which I hope were normal), but this is a good example of the hassles of modern healthcare. Imagine dealing with sick patients.
At the end of your next appointment, pull out some 8 page disability and FMLA forms and ask him to fill them out on his free time.
I should clarify that I actually like this particular doctor a lot. One thing I really appreciate about this particular doctor is that he regularly initiates conferences with the other specialists I’m dealing with and together they decide on a recommended course of care. I do appreciate that those kinds of conferences are difficult to put together and they are extremely valuable. So I’m not only full of complaints!
Years ago DH had a biopsy that came back right after the doctor had started a 2 week vacation. His staff refused to give DH the results causing an incredible amount a stress. We dropped that doc like a hot potato.
I feel the same way about PSAT results, which the College Board used to distribute through high schools, some of which held the reports for weeks until it was convenient for the counselors to disclose the results to students. From my perspective, if I paid for the test, I should have access to the results. Period.
Wanting to know the results and being able to handle the results are two different issues. You asked a question but seem pretty dissatisfied with the many reasonable answers given to you. Perhaps this is arguing for the sake of getting your frustration out. I won’t add anymore to this. I hope your results are benign.
I have a MD I like very much. I got several blood tests from her on 8/30 and wanted to be sure that my Torres for Hep A&B showed immunity, as there has been a recent Hep outbreak AND we are traveling out of country soon and were advised by travel agent to consider Hep shots if we weren’t currently immunized.
I waited patiently but did not hear back RE results. I finally called her office twice and she called back, confirming that I have high titer immunities to both Hep A&B, which is a huge relief and she will be having my results mailed to me.
I recognize how difficult it is for our MDs with EMRs, especially as many are incompatible with one another, making things extra challenging. I feel waiting 3 weeks prior to calling for results was reasonable.
She says I can set up an account with the lab and have access to all my lab results online.
I’m a primary care provider who either puts the results to be viewed on mychart within 1 week, calls, or sends out a letter in case the patient doesn’t have a mychart (most). I have had the stress twice waiting for biopsy results. Once for a breast biopsy for me and once for my son who was referred from Tufts to MGH to the Osteosarcoma specialist after a MRI. These were thankfully both negative, but for my son, it took over a week to get back to him. I have learned that negative results often “sit there” with the cancer specialist if they are negative while the busy specialist attends to curing cancer. I wish they would ask an assistant to call the patient. But, in the world of EMR, only the provider ordering the test can see the results and they must be managed in some way by the provider. For example, if it is a negative test and the patient needs to be called, it must be routed to someone else with a note. For some reason, many physicians are not as adept with the EMR (especially surgeons) and doing such a task is difficult, especially when dealing with multiple other reports, labs, phone calls, requests, orders…
OMG I have had the same issue recently! Fortunately, in my case, office staff seem able to relay results to me on the phone (though perhaps not release results online). But still, I had some anxious waiting days when it looked like a report was locked and I thought the worst.
Leaving people to worry about their results unnecessarily for weeks is doing harm.
But I realize that results must be reviewed prior to releasing them and that there are constraints on doctors’ time.
Might the solution lie in the greater use of nurse practitioners or physicians assistants? Could they review test results as they come in, flag the complex ones for the doctor, and then call all the other people? They wouldn’t need to be limited to providing “good news” results only. They could also handle some of the simpler “bad news” calls. For example, an NP or PA in a dermatologist’s office should be able to communicate the results “you have a basal cell carcinoma” in a way that ensures that the patient knows that the condition needs to be treated promptly but that with proper treatment, it’s not a life-threatening disease even though it’s a form of cancer.
As a nurse practitioner, I see my own patients, order the tests, and perform biopsies. I’m not sure why the physician would be better at delivering “bad news” results than myself who has a relationship with the patient. I might consult with a physician colleague or a specialist before giving the results as I want them set up soon with the appropriate provider for any “bad news” results. My consulting oncology group makes great use of Nurse Navigators who are RNs and really take care of patients from beginning to end.
But, lets say the physician had an “assistant” PA, NP, or RN, the message goes to the ordering provider (who might be the NP or PA) and that provider must route it with a message to someone else to call the patient if the results are negative. Again, those not proficient with electronic medical records may find this time consuming and difficult and therefore negatives may sit in the box.
I just read a article which says that 27% of a physician’s time is spent on face-to-face care while 59% is spent on charting. This leaves little time for evaluating results, phone calls, letters, and forms.
I think people really have no idea of what is being done to healthcare in terms of some of the back office Obamacare mandates with EMR’s. The workflows are complex, the systems don’t always interact so easily, there are limits to time and money. “Just having an assistant” deal with it requires an actual assistant and a line item budget for the FTE equivalent for that staff time. Given that growth is hard to come by, the budget can be a zero sum game - so what do you want your healthcare administrator to cut so you can have a human convey your negative test results immediately? And whatever you decide, realize that everything will change arbitrarily next year.
The idea expressed that “I paid for it so I demand it” is not in line with reality. When is the last time anyone went to a lab and paid a bill at the same time? I’m sure it has happened in history but just watch the front desk at a lab and see how much cash changes hands. Mostly nothing. Third party payers pay the bulk of your lab fees and they are the ultimately the de facto owners. I am certain that if patients started paying cash at point of service for all of their routine care that customer service would improve dramatically - because the patient and customer would then be identical. In today’s case the third party payer source is the customer while the patient is the patient.
Another confounding variable in the EHR mess is the consolidation driven by Obamacare. Small economies cannot survive so medical groups are merging and making massive cuts and consolidations. Every time it happens, a decision is made to streamline so where there were three EHR’s there are now one. But wait, not really. The transition to a new EHR requires maintaining the old EHR for a period of time because it is too impossible or too expensive to move the old data into the new database. And don’t forget that the hospital and the outpatient clinic use different EHR’s so now there are 4 EHR’s. Don’t forget the emergency room. They have a different product. Oh, I forgot radiology. And that hospital in the next town that turfs all the indigent patients our way - we have to be able to view those records. And today we merge with a new “partner” so we can anticipate changes again. But don’t worry all of this is toward the so-called quadruple aim: enhancing patient experience, improving population health, reducing costs, improving provider work satisfaction.
Don’t take me wrong - test results should be turned over as rapidly as possible for good care and patient satisfaction. But at the same time…
I think the group on CC is likely more informed and more educated than the average page. Remember, when all professions get together, the talk is about how stupid people are, from the ER nurse to the coffee shop barista, everyone talks about how stupid clients/customers are. So, the docs have to protect themselves legally from that clientele.
And HIPAA is a royal PITA, causing all sorts of issues with everyone’s legal teams wanting maximum protection.
For me, even if it was bad news, I would like to know ASAP. I think my doctor consultation would be more effective and productive if I had had time to think about and, yes, Dr. Google, the info so I could formulate good questions. Dr. Google is good for helping someone medically inclined to come up with questions on a topic that is new to them.
EHR’s are extremely complex databases. They have to deal with text, images, voice recordings. They have to ingest data from all sorts of different venues such as labs, radiology, sleep studies, etc. They have to deal with all the different specialties ranging from a dermatologist who spends 5 minute with a patient but does a lot of procedures to a psychiatrist who spends an hour and dictates a long dictation. The EHR has to manage billing, coding, scheduling, immunizations. The government requires that the EHR also manage and document patient education. It must also have a patient portal. Many of these functions also need reporting mechanisms - if you don’t prove that you and your patients are using the EHR per government guidelines they claw money back after audits. It has to have electronic prescribing functionality and interact with literally every pharmacy. It has to track the history of all prescribing and deal with the FDA drug scheduling and certain state prescribing rules (some must be printed on paper while most are submitted electronically. Many have functionality that allows providers and staff to communicate via internal email to pass tasks back and forth (e.g. reporting lab results to patients). They often have accounting modules for managing patient accounts receivable. They have functionality to ensure that government guidelines treatment guidelines are followed (this is now know as “quality”) or else face fines and clawbacks. You get the idea - this goes on and on. And then the rules change. And then a corporate merger.
It is certainly not that people are too stupid to understand the idea of an EHR. It is that smart people would never imagine that we would choose to use an EHR to do this to ourselves. By the way, I am an advocate of voluntary EHR’s that suit the clinical and business needs of the enterprise - just not the Soviet model.
I have my PCP and cardiologist in one hospital system and the rest of my specialist team in another hospital system. The PCP’s portal system is absolutely horrendous. You can barely send emails through it. Results are never uploaded and half of the features don’t work at all.
The other hospital system that I am in has the best portal system I’ve ever encountered. The results are uploaded as soon as the doctor’s office gets them which is usually about 2 days for blood and longer for other tests.
It makes zero sense to me that one system can be so horrendous and the other so seamless. I moved all of my specialists over to the other system because of the portal system.
One way to understand the difference is to think about Microsoft Windows. Who wants to pay to upgrade? What if you had to pay a million dollars? At some point, medical systems have a budget and cannot afford the most recent systems. Any upgrade leads to a significant decrease in productivity - how long does it take you to reformat your hard drive and re-install windows? When we roll out a new EHR we tell providers to expect a 33% reduction in productivity. They are all paid on productivity which means that they should expect a temporary pay cut or expect to work harder for less. After 6 months, as many as 1/3 of providers are still below where they were before the change.
Also, once a large system adopts an EHR it is subject to a monopoly force. The EHR vendor knows you can’t simply dump them - it would cost millions of dollars, doctors would leave, massive disruption, etc. So their responsiveness to suggestions for improvements tends to be on the low end. If you think it takes too long to get test results - just wait for the implementation of your suggested improvement in the EHR.
In a few years, maybe your specialists will be on the equivalent of Windows 90 while your PCP moves to a Mac and your experience will change. Another thing you might be seeing is simply where the money among medical specialties. PCP’s are at the bottom of the money ladder.
I pay $2000/year for my concierge doctor, which includes a very thorough physical, including any additional blood tests I might want that he wouldn’t normally order (like Vit D, although he does do that one routinely now, but didn’t always). I’m guessing all the blood work, EKG, and at least an hour I spend with him runs at least $750. And it’s all covered; I’ve never paid for anything from my annual physical. Then for some reason (I usually see him another 2-4 times a year depending on what else is going on), at my future check outs, the office manager tells me, “teriwtt, you have a credit with us, so no co-pay for today.” I’m not exactly sure what’s going on and how I’m rarely paying any other co-pays for the rest of the year; one year I got a refund check from them because I only saw him one other time that year, so I never used up all my credit. I know a couple of those years I reached my out-of-pocket maximum for the year and had all medical costs covered at 100% until the end of the year; honestly, I’d rather not have so many complications and NOT reach that maximum! I can’t remember what our annual deductible is, but it never seems to apply to the annual physical I have with him - in March, he’s usually the first of my ‘annual’ visits I have with my docs. I do realize some of this has to do with the excellent medical insurance we have, though, through H’s company.
Can’t remember who mentioned upthread about doctors charging for phone calls after hours. My GYN’s office recording now says if it is after office hours, you are requesting a call back that isn’t an emergency, he will charge you for those calls. He is also in solo practice - I suspect he was getting after hours calls from women who realized they were out of their meds and wanted refills that night. My endocrine surgeon (who I now use as my endocrinologist) is 86 years old!!! He works a couple of days a week, I think to keep his mind sharp (and it is), but is also in solo practice; I don’t think he utilizes EMR, but because he works because he loves it and still finds it fascinating (he is always filling me in on the newest studies on all kinds of medical issues I have), I doubt he cares about lower reimbursements for not using EMR. Funny thing is, every year when I see him, as I’m checking out, they always schedule my annual appointment for the following year. I don’t know how many more years I’ll be able to do that without asking, “What if…” or “How do you know…?” He’s one of those guys who in his heyday was considered one of the top three docs in his specialty across the country. I have no idea what I’m going to do when he retires or dies since he’s solo practice.
The one time I got the dreaded C diagnosis, the GYN who did the endometrial ablation (my GYN doesn’t do those procedures anymore, so refers out) called me on a Monday morning with the news. He told me he knew on Friday afternoon, but decided my worrying over the weekend and not being able to do anything about it wasn’t worth the phone call (honestly, we did the endometrial ablation due to heavy bleeding during perimenopause, and it just never occurred to me that I might have cancer, so I wasn’t even waiting for a biopsy result phone call). I’m SOOO glad he handled it that way - as it turned out, he gave me the name of a ONC GYN that morning, I called my concierge internist to confirm this was a reputable guy to go to, then called their office and was able to get in that afternoon. I don’t know how it could have gone more smoothly (other than not getting the diagnosis).
All this being said, about five years ago, I fired several of my doctors, the first one being my PCP - I loved him, but because he was the most popular doc there out of five, I had a hard time seeing him/talking to him when I needed to. When I found my concierge doc, and told him how unhappy I was with some of my other specialists, he gave me some awesome referrals, and I am finally in a place today where I am very happy with all of the docs I see regularly, except my dermatologist. The really great derm I had died a few years ago, and this is who his wife sold the practice to - I’m not very happy with it (they focus a lot on cosmetic procedures) - they do tell me whenever they do biopsies that I will only hear from them if it’s something to worry about; otherwise, I can call them in a couple of weeks for the results. Only once did they call and tell me I needed to come back in for follow up, and even then, it was almost an overreaction.
I do realize I’m VERY fortunate in most of my health care, with practitioners who care about me and health care coverage. Honestly, I try very hard not to take advantage of my physicians extraordinary care because I don’t want to even consider for a second that I could in any way or manner contribute to their burn out. I want them around for a long time!