by Kris McFalls
The U.S. Department of Health and Human Services (HHS) has proposed a change in federal regulations that would allow patients access to their laboratory test results without first going through the ordering physician. The proposed change is due to the fact that physicians fail to notify patients of abnormal test results about 7 percent of the time. There is both opposition and support for this change by physicians and other organizations.
I have always advocated that patients should acquire and keep copies of their lab work after their doctor has reviewed it. And I have never believed that patients should try to interpret lab results on their own. In fact, I would encourage patients who already have direct access to copies of lab work to make an appointment with their physician to jointly review the test results. However, a recent personal experienced has led me to believe that the HHS proposal may be a positive step for some patients.
A while back, one of my regular doctors moved. She was religious about mailing me copies of my lab work along with a note with instructions for follow-up. If something unusual showed up, she or one of her nurses also would call. When this doctor moved, I was forced to find another physician. Unfortunately, although a good physician, the new doctor did not have the same policy about sharing my lab work with me. What’s worse, unless I brought the subject up, I never heard anything at all about my blood work. Therefore, I signed the necessary releases to have the lab directly fax me a copy of the results.
Recently, that practice proved pivotal when I had my routine annual blood work. Like many patients with chronic illness, I keep copies of all of my lab work, and I know what is normal for me and what is not. This time, I noticed there was a significant change in one of my thyroid levels. Because the current thyroid level was still considered at the high end of normal by the lab technicians, it was not flagged as a potential problem. But, by comparing these lab results with past results, I was able to spot an upward trend that otherwise may have gone unnoticed for another year. As a result, I was able to make an appointment with my endocrinologist, who after an exam and a conversation about my symptoms, decided it was best for me to start thyroid replacement therapy before my thyroid disease further progressed.
Currently, it is not common for patients to gain direct access to their lab results, but some states and certain healthcare organizations do allow it. Additionally, some healthcare organizations make all medical records available electronically - even office notes. As a safety precaution, however, those same facilities delay the release of those results by a few days to give doctors time to review them before the patients have access. The HHS proposal does not have a specified waiting period.
Opponents of the HHS proposal fear that giving patients direct and immediate access to life-altering test results may increase patient anxiety, poorly influence the doctor-patient relationship and cause significant disruptions to the medical practice. Additionally, these opponents point out that some test results are devastating and should only be relayed to the patient by someone ready to counsel that patient and their family members.
Proponents, on the other hand, such as Quest Diagnostics, feel that giving patients access to lab results recognizes patients’ rights to their health data. Jon Cohen, MD, chief medical director at Quest, stated: “If you have your blood drawn, who owns that result? We believe it’s you, the patient. It’s your blood, your data, your results.”
Whether you are for or against the new proposal, you have the opportunity to express your wishes before a final ruling is made. The proposal can be read and comments can be made at www.regulations.gov/#!documentDetail;D=CMS-2011-0145-0001. Comments must be submitted no later than November 14, 2011.
Tell us what you think. Should patients have direct access to lab results?