Here is the thing... people get sick. And they get sick whether or not they have health insurance. And when they get sick, they come to the emergency room. And...
In the movie, A Few Good Men, the climax occurs when a military attorney played by Tom Cruise questions a colonel played by Jack Nicholson during a trial about a murder on a military base and Nicholson famously says: “You can’t handle the truth”. We now have a lot of physicians saying the same thing about releasing lab test results to patients.
Electronic medical records have changed the way we practice medicine in many ways. As physicians, we are focused on how EMRs affect how we practice medicine. But there are also big changes in the way that patients receive medical care and this is often under-appreciated. In this case, it involves who really owns a patient’s medical record: the doctor or the patient?
There is a long history of doctors and hospitals being loath to share medical records with patients or other doctors. Part of it has to do with HIPAA laws and the fear that medical records will fall into the wrong hands. Part if it has to do with the time and expense that it would previously take to photocopy records. Part of it has to do with a suspicion that anyone asking for medical records is planning on using it to judge or sue the physician. But part of it comes from a fear that patients are going to pester us about every minor lab abnormality and create additional work for us explaining insignificant results.
Enter the electronic medical record. We can now organize and disseminate medical information better and more rapidly than ever before. One of the features of EMRs is the ability to communicate with patients, including electronically releasing their test results to them. When we first acquired our electronic medical record, we did not automatically release any test results and the physician had to decide for each test result whether he or she would release the result electronically to the patient. After a few years, we changed it to auto-release basic test results (like chemistry blood tests and CBCs) after 5 days, thus allowing the ordering physician 5 days to review and act on any results prior to the patient seeing them.
Last year, at our James Cancer Hospital, we made blood test results available to inpatients immediately through their electronic medical record. The patients really liked this a great deal and it improved satisfaction scores. Although there was some concern that hospitalists would be “scooped” by patients who often saw their blood test results before the patient, this really didn’t materialize.
This summer, we extended the auto-release to outpatients. It is only for fairly basic lab tests and not for sensitive results like surgical pathology results, radiology results, or genetic tests. Our hope is that we can improve patient satisfaction but the initiative was met by a lot of resistance by some physicians who were concerned about a barrage of phone calls from patients worried about insignificant test results.
Enter the monocyte count. When you order a complete blood count (CBC), you get 19 different results, most of which, you don’t really care about. One of the ones that most physicians care the least about is the monocyte count that rarely means anything significant if it is too high or too low. But if patients see that monocyte count as being abnormally elevated, they can panic because they don’t know if it is important or not. So the fear that was perpetuated by some of our physicians is that they were going to get inundated by panicky phone calls from patients worried about their abnormal monocyte counts.
My own opinion is that the medical records belong to the patient and not the doctor and patients have the right to see their blood test results. Personally, when I see my own doctor, I really like being able to immediately see what my routine cholesterol, hemoglobin A1C, or hemoglobin is when I’m in for my annual check-up. Most patients are a lot more sophisticated today than they were 20 years ago, before the advent of EMRs, and most patient are like me, they want and expect to see their lab results right away.
So far, I’ve only had one patient call about his high monocyte count after hundreds of immediately released lab tests. It is a pretty small price to pay for improved patient satisfaction. Personally, I think patients can handle the truth.
September 27, 2016