Among the glaring deficiencies of health care in America today are 2 problems for patients that occur frequently but are rarely mentioned in the medical literature. One is waiting weeks to months for a doctor's appointment.1  The other is the subject of this editorial—waiting for test results.2–4 

Anxiety, Anger, and Frustration

Family members and friends often turn to me for medical advice. Most of our conversations focus on the slew of tests or imaging procedures that they have undergone to establish baseline values or to discover the cause of their illness. Nearly every time, the problem boils down to this: when patients don't get their results, they feel ignored, resentful, and sometimes frightened.

In view of the professional ethics involved, my first question is always, “What does your doctor say about this matter?” The replies vary from “I haven't spoken with her,” to “I didn't want to bother him,” or “I tried and tried to speak directly to my doctor, but I never got past the receptionist.”

Next I ask, “How long have you been waiting for the results?” Answers: several weeks to several months, and, in one case, a year—after which the patient gave up and switched doctors.

I always wonder why these patients don't hound their doctors for the answers, which they have every right to know. Some patients have taken that approach, but to no avail. Others are reluctant to press the issue, fearful of being labeled a complainer or disruptor of office procedures, or of being punished somehow.

Fortunately, in almost every case, the patient ultimately obtains the results. But the manner in which the results surface is typically impersonal: a computer printout in the regular mail, an online version accessible by security code, a recorded message from the doctor's office, or an actual phone call from the office nurse or laboratory assistant. Rarely does the doctor personally notify the patient. Even then, the news might not be delivered until the next scheduled appointment, possibly months later.

In a few instances, these patients have been told up front that no phone call or report from the doctor means that the results are normal. But because they are not given a specific cutoff date for waiting, that approach seems inconsiderate and inappropriate. I know of one case in which the results were abnormal but somehow got misplaced, and the doctor never saw the report until the patient's wife called the office in desperation 4 months later.

More on the Transmission

I recognize that the examples presented here do not necessarily represent our profession as a whole and that many factors—some unavoidable, some uncontrollable, some both—influence the manner of notification, or lack thereof. Nevertheless, I see no valid reason why any patient should wait more than a week for the results of routine laboratory tests and imaging procedures or longer than 72 hours for most biopsy reports. In that regard, a recent large study showed that outpatients expect their imaging results within 1 to 3 days and will call providers within 1 to 5 days.2  Moreover, the emotional impact of a long wait can adversely affect the patient's ability to process test results.3 

My personal physician handles this issue well and has done so for the past 40 years. For biopsies, he always speaks directly with the patient on the day when he, himself, gets the answer. For all other tests and procedures, he sends a personal letter to the patient several days after the office visit. In the letter, he details the test results; explains their medical significance; describes what the patient should do in response, if anything; mentions his plan; confirms the next office appointment; and encourages the patient to inform him of any medical issues that occur in the interim.

Reminder

A founding principle of our profession is that patients are our masters and that we are their servants. In that light, we physicians should always recognize our patients' concerns, anticipate their fears, and honor their right to know—in a timely fashion—the results of every test and procedure they undergo.

References

References
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Waiting for radiology test results: patient expectations and emotional disutility
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Waiting is the hardest part: anticipating medical test results affects processing and recall of important information
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Author notes

Dr. Herb Fred died on 30 December 2018. A coda to his life and work is planned for the next issue of the Journal.