During a months-long quest to resolve unexplained fatigue and joint pain, Rachel Horner took more than a dozen blood tests. To get test results, she typically had to schedule in-person appointments. Some weeks, she trudged into multiple doctors’ offices just to hear that her blood work had come back normal.
“After any request for a test or blood work, they make me schedule a follow-up before I leave the office,” says Horner, who lives in Los Angeles. “Thankfully my work is understanding, but I don’t understand why I can’t just get a phone call.”
Waiting for the results of any medical test, whether it’s routine blood work, a pregnancy test or a biopsy, can be a stressful experience. Some doctors call, text or email patients with results, while others require in-person visits. No federal or state law dictates how or when doctors share test results with patients — so legally, both approaches are fine.
“Patient-provider communications are largely unregulated,” says Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation. So, in effect, providers, practices and hospitals determine their own policies.
Most providers who require follow-up visits to share test results have a reason for doing so, Donovan says, and aren’t just trying to bill extra time: “They may want to be able to deliver bad news in a controlled environment where they can also discuss a treatment plan.”
That doesn’t mean patients have to get on the same page. If you want to get results by phone or email, it’s within your rights to ask. But before you speak up, make sure you understand what doctors need to consider, and what patients are owed, when it comes to communicating medical news.
What your doctor is thinking
For years, Dennis Gingrich, a family physician in Hershey, Pennsylvania, mailed lab results to patients. He’d also share results over the phone, or let a nurse do it on his behalf, but only after he’d reviewed the results and the patient had provided two forms of identity verification.
“Some patients like a personal touch,” Gingrich says, “but phone calls are time-consuming.”
Gingrich has also timed blood work just before a patient’s already scheduled visit so they can talk about results in person without having to make an additional appointment.
“Ultimately, it’s the patient’s information,” he says, “and it should be accessible to them.”
Siobahn Hruby, an internist in Little Rock, Arkansas, says that large university hospitals often hold onto lab results for up to a week so that doctors have time to review them before they’re released. Hruby has also seen front desk staff at some clinics tell patients they have their results, but they can’t give them out.
“The main reason [office staff may refuse to hand over results] is that the person giving you the results should be able to interpret them and know what the next step is,” she says.
Some screening tests for diseases, for example, are more prone to false positives. So even if a patient receives an initial positive result, it might not mean they have the disease in question. “The only person who’s really qualified to talk to you about that is your physician,” says Hruby.
The move to patient portals
Gingrich’s office recently started giving out lab results electronically, but Gingrich would never email results. He worries about providing security without a top-notch encryption system. Instead, his office has a patient portal, which is a secure online system where patients can log in to view test results and message their doctors. Portals also serve as a central repository for lab results. Many doctor’s offices, like Gingrich’s, upload them to the portal as soon as they come in.
One recent study found that portals can positively affect patient satisfaction and retention. In a 2016 case study, a family physician in North Carolina estimated his practice’s portal resulted in 10,000 fewer phone calls to his office each year.
“Patients have direct access to blood tests, imaging reports and notes,” says Gingrich. “Some patients like that, others haven’t adapted to it. It’s quite variable.”
Hruby sends most test results via her practice’s portal: She writes a summary explaining what a patient’s results mean and lets them know whether she recommends follow-up care. Test results are usually posted in the portal, with Hruby’s summary, the same day they’re received or the day after. For older patients who aren’t comfortable with the technology, she still prints out letters and mails results.
In Baltimore, Laura Laing gets regular blood work done because of her hypothyroidism. She sees two doctors, at different medical centers, to manage the condition. Both use patient portals to share lab results. Before, Laing says, she only heard about results if they were abnormal. Now, results are promptly uploaded to the portal and Laing receives an email notification that they’re ready. “I love the system my doctors use,” she says. “The summaries are super easy to follow, and I’ve found myself looking through my blood work results to check each of the levels.”
Getting results on your own
You can also get results directly from a lab. Patients who register with Quest Diagnostics, for example, can access most results in the Quest system within seven to 10 days.
A 2014 federal regulation — the lab test result data access rule — guaranteed patients in all 50 states the right to access the results of tests performed by freestanding labs as opposed to a lab in a hospital or doctor’s office. Before that, patients in some states had direct access to lab results, while other states required a doctor’s permission for direct access, and still others forbade it altogether.
Hruby and Gingrich are all for giving patients direct access. But they both have concerns that patients who see slightly abnormal test results — either in a report sent directly from a lab or in a patient portal patient — without any explanation from a doctor will worry unnecessarily. “People get very anxious,” Hruby says.
Almost every blood test should be interpreted in relation to past blood tests, current medications and diseases, and age, she says. A lab company can’t do that; only a physician can. “And it’s not the kind of thing you can Google,” says Hruby.
That doesn’t mean every portal does its job perfectly. A recent study found that almost two-thirds of patients who obtained test results from a portal received no explanatory information. Nearly half of those patients then conducted online searches, and many with abnormal results ended up calling their doctors. Another study found that while portals help patients participate more actively in their healthcare, they also may increase anxiety. Yet another study showed that more patients are receiving serious diagnoses over the phone, which in part could be due to doctors wanting to get ahead of patients seeing the news on a patient portal.
Still, portals do help ensure that patients receive their results, and quickly. Past studies have shown that between 8 and 26 percent of abnormal lab results were not communicated to patients promptly.
What patients are owed
The American Medical Association has general guidelines for physicians on how to communicate clinical results. Patients should get results in a “timely fashion” and doctors should be “considerate of patient concerns and anxieties.”
Doctors should let patients know how results will be conveyed, when the results will come in, and what to do if they don’t hear back in that time frame, says the AMA.
When Hruby orders a test, she always gives patients an idea of when results will be ready. “It’s a fair question to ask,” she says. “You can certainly ask your doctor that.”
Patients should also assume that “no news is no news,” she says, and not necessarily good news. If you haven’t received results after a reasonable amount of time, follow up. “Definitely take ownership,” she says.
Donovan adds that, when it comes to getting test results, “the process should be transparent and patients should consent to it as part of the check-in process.”