My gynecologist's office never calls to tell me my annual Pap smear is fine. And I've been guessing the strep test my 9-year-old son had 10 days ago was normal, since my pediatrician didn't contact me. But I'm mistaken in my assumptions and shouldn't rest easy. That's according to a new study published in yesterday's Archives of Internal Medicine , which finds that 7 percent of abnormal results aren't reported to patients. "You can't assume that no news is good news," stresses study author Lawrence Casalino, an associate professor of public health at Weill Cornell Medical College in New York City.
That's the case even if your doctor tells you not to expect a call unless there's an abnormality. Despite the fact that the Agency for Healthcare Research and Quality tells doctors to inform patients of all test results, nearly one third of the practices surveyed in the study didn't do so. Practices that use "no news is good news" policies and have no good system in place for managing test results—like having the physician sign off on all results—are more likely to neglect to inform patients about negative results. "We didn't see any missed cancers, but we did see cases where women weren't told that they needed a repeat Pap smear or mammogram in three months to follow up on an abnormal finding," says Casalino. (Unfortunately, doctors don't get reimbursed for delivering test results, just for ordering tests. Perhaps this should be put high on the healthcare reform priority list.)
In fact, Casalino tells me a missed test result in a close family member was what spurred him to do the study in the first place. "It was after she went back for her regular Pap smear that she found out that a vaginal ultrasound she had 15 months earlier was suspicious for endometrial cancer," he says. The doctor, he adds, literally turned white after seeing that the patient never was told to have a follow-up ultrasound. Thankfully, there was no cancer.
What should women do to ensure this never happens to them? Casalino suggests the following three actions—which I'm going to make a point to do from now on.
* Call for any and all test results. Ask your doctor's office to call you either way to tell you the result of a test. And find out when you should expect to hear. If you don't hear by that time, make the call yourself.
* Switch doctors if your phone calls aren't returned. If it takes your doctor three days to get back to you, it could be a sign that the office is not well managed. If that's the case, there's a good chance your test results could be ignored or misplaced.
* Don't assume electronic medical records safeguard against missed results. Medical practices relying on paper records were no more likely to miss abnormal test results than those with electronic medical records. Interestingly, those with a mixture of both had the worst score cards. Casalino says that's probably because they're in a transitional state of changing their procedures, allowing results to more easily fall through the cracks.