Risks and benefits of direct access to lab results
From the 5 January 2012 posting by PATRICIA SALBER, MD at KevinMD.com
I am a big fan of DIY (do-it-yourself) healthcare, at least for the bulk relatively minor issues that plague people. I think the days when doctors were needed to control, interpret and dole out health data and information are waning. There are simply too many ways, primarily via the internet, to get good, reliable, easy-to-understand information about our own health.
The Quantified Self (QS) people who use sensors, mobile apps, and other devices to collect data on themselves may be taking it to what some would consider extreme, but I think it is the wave of the future.
Now, no one would question who “owns” the data collected in this manner, but how about data collected via a medical laboratory? Is that somehow different and something we, the patients, should not be allowed direct access to lest we harm ourselves by misinterpretation. Interesting question!
The issue is explored in a commentary in the December 14, 2011 issue of the Journal of the American Medical Association.*** Traber Davis Giardina, MA, MSW and Hardeep Singh MD, MPH, ask the question: “Should patients get direct access to their laboratory test results?” They find that it is “an answer with many questions.”…
The reason to raise this question now is that there is a proposed rule by the Department of Health and Human Services in conjunction with the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention and the Office for Civil Rights, that would allow individuals the ability to access their test results directly from the laboratory by written or electronic request. …
…
There are a number of reasons why direct access is a good idea:
- Between 8 and 26% of abnormal test results, including those suspicious for cancer, are not followed up in a timely manner. Direct access could help reduce the number of times this occurs
Self-management, particularly of chronic illness has known benefits. Just like the QS people, many folks with chronic illness obtain and manage to self-acquired lab results every day via glucometers, home pulmonary function tests, blood pressure measurements, and so forth. Direct access to laboratory-acquired data, one could argue is a continuation of that personal responsibility…
…
The arguments against direct access discussed by Giardina and Singh include the following:
- Studies show that patients prefer their physicians contact them directly when they have abnormal test results, although the studies, published in 2005 and 2009, preceded the extraordinary use of the internet to access health information that exists today.
- There is concern over whether patients will know what to do when they receive the results – will they make erroneous interpretations or fail to contact their docs? …..
***Article available online to paid subscribers only.
For suggestions on how to get this article for free or at low cost, click here
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- Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions (jflahiff.wordpress.com)
- Proposal on access to lab tests should be revised, doctors say (kboreilly.com)
- Progress Made on Direct Patient Access to Lab Results (projecthealthdesign.typepad.com)
- Getting Lab Results Directly to Patients (blogs.wsj.com)
- Becoming a master diagnostician – Step 3 – lab test interpretation (medrants.com)
- Dentists Could Screen 20 Million Americans For Chronic Physical Illnesses (medicalnewstoday.com)
- Support Your Right to Access Your Clinical Lab Results (spittoon.23andme.com)
- Docs Don’t Want Lab Results Going To Patients (informationweek.com)
- HHS wants to give patients test results straight from the lab (kboreilly.com)
- HHS Proposed Regs Would Give Patients Direct Access to Lab Results (physicianlaw.foxrothschild.com)
Doctors Are Cautious, Patients Enthusiastic About Sharing Medical Notes
From the 19 December 2011 Beth Medical Newsletter
Study gauges baseline interest in three-site OpenNotes trial
Date: 12/19/2011
BIDMC Contact: Jerry Berger
Phone: 617-667-7308
Email:jberger@bidmc.harvard.eduBOSTON – Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests….
bcpid817305526001?bckey=AQ~~,AAAAAFqngE4~,1T5CVJLflDgH5Vlf5BfgldQPJ39fiMEk&bctid=1318343417001
While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated that they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried
“The enthusiasm of patients exceeded our expectations,” wrote Walker. “Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics.”
More than 90 percent favored making the notes available. Well over half anticipated improved adherence to their medications, 90 percent expected to feel more in control of their care, and four out of five predicted they would take better care of themselves….
Related articles
- Doctors are cautious, patients enthusiastic about sharing medical notes (eurekalert.org)
- Patients eager to see doctor’s notes; physicians, not so much (seattletimes.nwsource.com)
- Patients Want to See What Doctors Write about Them, Says Survey (onehealthyblog.wordpress.com)
- Patients, Docs Differ on Online Notes (abcnews.go.com)
- Patients Want Electronic Link To Doctor’s Notes (informationweek.com)
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
Do You Really Need a Yearly Checkup? | Yahoo! Health
Do You Really Need a Yearly Checkup? | Yahoo! Health By Lisa Collier Cool
Excerpt
Typically, a routine visit with your primary care doctor involves a slew of tests and screenings. While patients are often told that all this poking and prodding is crucial to protect their health, is there any scientific evidence to support that? A decade ago, the US Preventative Services Task Force (USPSTF), an independent group of medical experts appointed by Congress, concluded that yearly physicals are unnecessary for healthy, symptom-free adults.
What’s more, a new study published in Archives of Internal Medicine*** reports that primary care doctors often order unnecessary and inappropriate tests, screenings and treatments, costing the healthcare system—and patients—$6.8 billion in 2009. The annual checkup is a prime culprit in needlessly driving up medical bills, the researchers found, with dubious or worthless tests ordered in up to 56 percent of these exams.
Find out how to save big on rising healthcare costs.
Instead of a yearly checkup, the new thinking is that healthy patients should “check in” with their doctors periodically, on a schedule tailored to their individual needs, to discuss any medical concerns and which tests truly are appropriate for their age, gender, and family history. Here’s a look at routine screenings that primary care doctors are most likely to use needlessly, according to analysis by the National Physicians Alliance (NPA)—and when these tests are worthwhile….
Read the article (it includes comments about specific tests)
Related articles
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
- Top 5” Lists Top $5 Billion in Potential Savings (National Physicians Alliance)
- How much guidance do patients want with their medical decisions? (kevinmd.com)
- What Makes Patients Complex? Ask Their Primary Care Physicians (medicalnewstoday.com)
- What makes patients complex? Ask their primary care physicians (eurekalert.org)
- Let physician assistants be part of the primary care answer (kevinmd.com)
***The article, “Top 5″ Lists Top $5 Billion, is available online only through paid subscription.
Click here for suggestions on how to get this article (and other science/medicine articles) for free or at low cost
Here are the first 150 words of the Top 5 article from the Archives of Internal Medicine Web page
Minal S. Kale, MD; Tara F. Bishop, MD, MPH; Alex D. Federman, MD, MPH; Salomeh Keyhani, MD, MPH
Arch Intern Med. 2011;171(20):1856-1858. doi:10.1001/archinternmed.2011.501
Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. The Good Stewardship Working Group presented the top 5 overused clinical activities across 3 primary care specialties (pediatrics, internal medicine, and family medicine), as chosen by physician panel consensus.1 All activities were believed to be common in primary care but of little benefit to patients. We examined the frequency and associated costs of these activities using a national sample of ambulatory care visits.
Methods
We performed a cross-sectional analysis using data from the 2009 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). The NAMCS and NHAMCS survey patient visits to physicians in non–federally funded, non–hospital-based offices and non–federally funded hospital outpatient departments, respectively.2
We limited our sample to visits by patients to their primary care physicians. Visits for each “top 5″ primary care activity were identified . . . [Full Text of this Article]
How much guidance do patients want with their medical decisions?
by KEVIN PHO, MD at KevinMD.com
The following column was published on November 10, 2011 inMedical Economics.
I recently saw two patients in my primary care clinic, each with new-onset hypertension.
The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on what to do next. He considered and appreciated my input but made it clear that the ultimate decision was his.
The second was an elderly gentleman in his 70s. Again, I discussed the various management approaches and then gave my opinion on what we should do. In contrast to the other patient, he said, “I want to do whatever you suggest. After all, you’re the doctor.”
As a publisher of a social media health Web site, I’ve observed closely the growth of the patient empowerment movement, facilitated by the Web making health information more accessible. According to the Pew Internet and American Life Project, 80% of Internet users go online to research their health, and this effort gives patients a greater voice in their care. Paternalistic decision making that traditionally drove the doctor-patient relationship slowly is being replaced by shared decisions. But not all patients embrace their new decision-making role.
In a recent study from the Journal of Medical Ethics, researchers interviewed more than 8,000 patients. Almost all wanted doctors to offer choices and help consider their options, but two-thirds preferred that the final medical decision to be left to the physician.
According to Farr A. Curlin, MD, an associate professor of medicine at the University of Chicago and one of the authors of the study, “the data [say] decisively that most patients don’t want to make these decisions on their own.”
There is a spectrum of how much physician involvement patients want. Some may want physicians only to suggest and inform but leave the ultimate decision to them. Others prefer doctors to have the final say.
The only way to know a patient’s preference is through a continuous relationship where that comfort level can be developed over time. After several encounters, a clinician should have a sense of how much, or how little, direction a patient needs.
Sadly, two factors in healthcare today work against such a sustained doctor-patient relationship. One is the fragmentation of medical care. More patients are seeing not only a primary care physician (PCP) in a clinic, but also a hospitalist when admitted to a hospital, along with an array of specialists both in the hospital and the clinic. According to a New England Journal of Medicine study, Medicare beneficiaries saw an average of two primary care physicians and five specialists working in four different practices. Without knowing the patient well, each provider may differ with his or her input in the medical decision process, which can frustrate patients who may have their own ideas of how much their doctors should be involved.
Next, consider the decay of primary care itself. There is a profound shortage of PCPs, with the American College of Physicians noting that “primary care, the backbone of the nation’s healthcare system, is at grave risk of collapse.” Patients who cannot schedule timely primary care appointments go to the emergency department, where they encounter clinicians they’ve never met before. The shortage is compounded by what is shown in the results of an Annals of Internal Medicine survey, which revealed that 30% of PCPs were likely to leave the field, citing burnout from time pressures, a chaotic work pace, and little control over their work. Both the shortage and attrition of primary care providers worsen the odds of forming long-term relationships with patients.
Having known my two patients with hypertension for years, I anticipated how much physician involvement they would need to make a treatment decision and was able to tailor my approach to meet their individual expectations. During this turbulent period of healthcare reform, we cannot lose sight of the importance of a continuous relationship between doctors and patients. Otherwise, our fragmented health system and deterioration of primary care will make it challenging to provide the proper amount of guidance for patient medical decisions.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.
Related Resources
- The Social Life of Health Information(Pew Internet Report)OVERVIEW
The internet has changed people’s relationships with information. Our data consistently show that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.
- Predictors of hospitalised patients’ preferences for physician-directed medical decision-making (Journal of Medical Ethics, June 2011)
Abstract
Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions…
Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small.
- Choosing Wisely (an initiative of the ABIM Foundation)
- What Makes Patients Complex? Ask Their Primary Care Physicians (medicalnewstoday.com)
- What makes patients complex? Ask their primary care physicians (medicalxpress.com)
- Letting Doctors Make the Tough Decisions (jflahiff.wordpress)
- What makes patients complex? Ask their primary care physicians (eurekalert.org)
- Make an informed judgment on the abilities of your surgeon (kevinmd.com)
- Let physician assistants be part of the primary care answer (kevinmd.com)
- Patients eager to see doctor’s notes; physicians, not so much (seattletimes.nwsource.com)
- The primary care doc fix is in (kevinmd.com)
- Letting Doctors Make the Tough Decisions (New York Times)
ACR in Choosing Wisely campaign to promote wise use of resources among physicians and patients
From the 14 December press release via Eureka Alerts
As part of its ongoing efforts to ensure safe, effective and appropriate medical imaging, the American College of Radiology has joined the ABIM Foundation and eight other medical specialty societies in Choosing Wisely. The new campaign promotes wise choices by physicians and patients to improve health outcomes, avoid unnecessary interventions and make efficient use of healthcare dollars.
The ACR will develop a list of five things to reduce unnecessary imaging exams ordered by physicians and improve quality of care. The list names imaging exams whose necessity should be discussed before being ordered. The list also equips providers with steps to help ensure safe, appropriate use of scans.
“Medical imaging exams are a perfect fit for Choosing Wisely. Scans lower healthcare costs by replacing more invasive surgeries and allowing for shorter hospital stays. Although imaging use is down significantly since 2008 and Medicare spending on imaging is the same as in 2004, opportunities remain to ensure appropriate ordering of scans. As greater access to imaging is directly tied to increased life expectancy, ACR will identify areas where care can be improved without restricting patient access,” said John A. Patti, MD, FACR, chair of the ACR Board of Chancellors……
…….
The ACR list, and those of other Choosing Wisely partners, will be released in April 2012. To learn more, visit ChoosingWisely.org.
The ChoosingWisely Web page includes the following under Resources
This series of six video vignettes featuring physicians and patients emerged from research the ABIM Foundation conducted to better understand public and professional attitudes about stewardship of finite resources. Watch the videos.
Related articles
Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions
From the November 28 article in the Journal of the American Medical Association
In the outpatient setting, between 8% and 26% of abnormal test results, including those suspicious for malignancy, are not followed up in a timely manner.1,2Despite the use of electronic health records (EHRs) to facilitate communication of test results, follow-up remains a significant safety challenge. In an effort to mitigate delays, some systems have adopted a time-delayed direct notification of test results to patients (ie, releasing them after 3 to 7 days to allow physicians to review them).3,4
On September 14, 2011, the Department of Health and Human Services jointly with the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Office for Civil Rights5 proposed a rule allowing patients to access test results directly from the laboratory by request (paper or electronic). …
Related articles
- When patients see their medical record (kevinMD.com, January 2012)
“The study found that doctors worried that open visit notes would result in greater confusion and worry among patients and they anticipated more patient questions between visits. But the patients overwhelmingly wanted to see the notes and were not worried about being confused. They thought seeing their own record would provide information that would help them be healthier. They could see the treatment plans and the test results directly.”
Risks and benefits of direct access to lab results (jflahiff.wordpress.com)
- Should Patients Get Direct Access to Their Laboratory Test Results? An Answer With Many Questions (jflahiff.wordpress.com)
- Risks and benefits of direct access to lab results (kevinmd.com)
Participatory healthcare: A parody? « ScienceRoll
Participatory healthcare: A parody? « ScienceRoll.
A 1 1/2 minute cartoon where a nurse slowly convinces a doctor on why the Internet is useful in patient education.
Ethics Forum Speaker KevinMD: Social Media Gives Doctors a Voice
Posted on November 9th, 2011 by Erica NoonanWe recently caught up with Dr. Kevin Pho, MD, a Boston University-trained internist now practicing in Nashua, NH. His website, KevinMD.com, is one of the Internet’s top sites for physician commentary and news.
Dr. Pho is a featured speaker at the Massachusetts Medical Society’s Ethics Forum,“Social Media and Medicine: the Impact on Your Patients, Your Practice, and You,” onFriday, Dec. 2, 2011, from 3:30 p.m. – 5:30 p.m.
MMS: Why should physicians get involved with social media?
Dr. Pho: We know that social media is important to patients. A Pew study says that 8 out of 10 of Internet users are online looking for medical information, but only 25 percent of them check the source of what they find. There is lots of bad information out there. I’ll be making the case for doctors to be online, guiding patients to good information.
Another reason is that social media is gives doctors a voice in national debates they didn’t have 5 or 10 years ago. With these (social media) platforms, we can introduce topics we think are important to a wide audience.
MMS: Many doctors say they just don’t feel comfortable with social media sharing sites like Facebook, LinkedIn and Twitter.
Dr. Pho: Doctors need an online presence and digital footprint. Patients will be looking for them online, and gone are the days where they will be using the phone book. I tell people, you really need to control your own social media presence….
Related item
Using Social Media For Practicing Evidence Based Medicine Cochrane Social Media Workshop 2011 (slideshare presentation)
Why doctors can’t say no
Often it’s easier to just say yes. But there are ways to say no that are better for both physician and patient
BY RAHUL K. PARIKH at the 28 November 2011 edition of Salon
Doctors routinely meet with patients who make requests for specific medicines, tests and referrals to specialists. In this era of the Internet, consumer-driven healthcare and direct-to-consumer drug marketing, this is no surprise. And while an informed patient is a good thing, what may surprise you is just how hard it is for doctors to say no when a patient makes a specific request for something he or she doesn’t really need.
Right now, Dr. Conrad Murray sits in jail because he couldn’t say no to Michael Jackson when Propofol came up in conversation between them. But even doctors who aren’t tempted by an enormous monthly retainer and access to one of the world’s biggest celebrities are challenged by the word “no.”
American medicine is a business — but a weird one. In any other sector of our economy, businesses are determined to give their customers what they want, however they want it. But in medicine, the “have it your way” mind-set doesn’t always jive. First, physicians have a duty to avoid doing harm. The choice of a drug or test based solely on a patient’s request can undermine that. Second, as everybody knows, we spend a big slice of our GDP on healthcare. Since the person who has control over expensive tests and the prescription pad is your doctor, there’s ever-increasing scrutiny to be responsible stewards of healthcare dollars….
…
The lesson here is that it’s best for the doctor and the patient to get everything out in the open, and for a healthcare system that affords the right amount of access and time — especially in primary care — to make that to happen.
Related articles
5 reasons why physicians will love mobile health
by DAVID LEE SCHER, MD in the 28 Nov 2011 edition of KevinMD.com
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician who they get to see for a big 15 minutes that the electronic record time slot permits? Or that they are caregivers to others and sacrifice their own well-being for that higher purpose?…
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About
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner. (For those wishing to see pictures of a 2009 Friends of Liberia service trip to this West African country, please visit www.fol.org. My photo album is included).
Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.com
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This blog is a companion site to my Health and Medical News and Resources Web site with…
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My professional work experience and education includes over 10 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news,
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