Malpractice Consult

•  Failing to report test results is a chronic problem that can lead to malpractice suits.

• A no-news-is-good-news policy is dangerous, because lab reports can slip through the cracks.

• It's insensitive to report abnormal test results by leaving a message on an answering machine.

Q: We've had some confusion in our office lately about the proper procedure for reporting test results to patients. Some patients claim they've never received the reports, and some seem to misinterpret the results. Can you suggest some guidelines to help us avoid liability?

A: The way doctors report test results to patients—or don't report them—is a chronic problem in many practices, one that can contribute to malpractice suits involving delayed diagnosis, serious injury, and even death.

Some doctors tell patients, "If you don't hear from us, you can assume your tests are normal." This no-news-is-good-news policy can be dangerous, because lab reports can slip through the cracks. The lab might fail to send the test result; or it might send the result to the wrong physician. To avoid this, your office should have a mechanism for ensuring that results for ordered tests are actually received from labs or radiologists. A simple tickler file might be enough.

Another problem is that your staff may not reach the patient with the results the first time, and then fail to follow up; or they may reach a family member who forgets to pass the report on to the patient.

To reduce liability risk, your office should inform patients of all test results, whether normal or abnormal. And you should tell patients that this is your policy. (Because of the potential for misinterpretation, many physicians no longer use the terms "negative" and "positive" when reporting test results to laymen.) After a physician has reviewed and initialed test result reports, a staff member can notify patients about normal results in one of the following ways:

Phone: Ask patients to phone the office for results a certain number of days after tests are submitted. Or ask patients if you may phone the results to them. If they agree, get their permission to leave a message on an answering machine or with whoever answers the phone. Document all calls.

Regular mail: Use a standard form with a brief statement such as, "Good news. The results of the following tests (list them) performed on (date) were normal. Please contact us if you have questions." Keep a copy of the form in the patient's chart.

E-mail: Advise patients that e-mail transmissions may not be secure. Request an e-mail receipt (a feature of some e-mail programs) or ask the patient to acknowledge receipt of the test results by return e-mail. Save a copy of your e-mail in the patient's chart.

Whatever method you use to advise patients of test results, tell patients to contact the office if they have not heard or received results within 10 to 20 days.

Abnormal test results deserve the physician's personal attention. He or she should report them to the patient directly—especially if they suggest a possibility of a serious disease or life-threatening condition, or if new or different treatment, tests, or medications are needed.

It's insensitive and unsafe to send abnormal test results by mail, or to leave a message on an answering machine. It's also inappropriate to let an aide communicate such information. Only a physician can properly answer questions the patient is likely to ask about the significance of abnormal test results, the long-range prognosis, and any required follow-up.

David Karp. Malpractice Consult: Delivering test results. Medical Economics Sep. 17, 2004;81:62.