Doctors should return test results faster
Last summer, a 55-year-old teacher from Dover had a CT scan that showed a suspicious mass on her left ovary, but the test wasn't conclusive. So her gynecologist ordered an MRI, which the patient had on a Wednesday. The lab technicians told her it would take a day or so to get the results.
Worried that the mass might be ovarian cancer, the patient called her gynecologist on Thursday -- and Friday. "I couldn't reach her. I kept getting her secretary," said the woman, who didn't want her name used. It wasn't until the following Monday that she got the results, which suggested the mass might not be cancerous after all.
The woman, who may change gynecologists because of the incident, was furious that it took so long to get an answer that had supposedly been ready for days.
"The waiting was difficult, trying to keep positive and optimistic when you know that something is growing inside you," she said.
Waiting for tests is often the most frustrating, anxiety-provoking part of medical care. And there is less and less excuse for it.
"There is no reason why a test result cannot be offered to the physician within 24 hours," said Dr. Howard Forman, vice chairman of diagnostic radiology at the Yale University School of Medicine; not just blood tests, he said, but X-rays, CT and MRI scans.
Five years ago, there was a good reason for delays in radiological testing because old films used for comparisons had to be retrieved physically from the files. "Now, most departments are digital, or could be if they chose," Forman said. "We have instant retrievability of prior images, so that is no longer an excuse. A radiology report should be provided within 24 hours in 99 percent of cases."
Performing a CT scan takes 15 minutes; an MRI might take 30 to 45 minutes, said Dr. David Levin, former chairman of the radiology department at Thomas Jefferson University Hospital in Philadelphia. "In a complicated case, it could take up to half an hour to read the scans."
Voice-recognition technology also dramatically shortens the time it takes a radiologist to finalize a report. In the past, doctors had to dictate a report, have it typed up, edit it, then mail it to the referring doctor, which took several days. Now, he said, computers process the radiologist's voice, creating an instant written report.
"We have the technology to make the readings and even digital images available to physicians automatically within seconds of the images being read by a radiologist," Dr. William M. Tierney, director of the division of general medicine and geriatrics at the Indiana University School of Medicine, stated in an e-mail interview.
But things often bog down, partly from sheer volume. A study at Brigham and Women's Hospital showed that the average primary-care doctor receives dozens of test results a day, said John Glaser, chief information officer at the Partners HealthCare system, which includes Brigham and Women's.
Some medical systems have already figured out a way to shorten the time it takes for patients to get results.
Beth Israel Deaconess Medical Center, for instance, has a Web-based system called PatientSite that allows patients to log on and see certain test results, even before their regular doctor does. "If you are a patient, you have much more interest in knowing these test results than the doctor does," said Dr. Daniel Sands, one of the creators of PatientSite. To avoid unnecessarily alarming patients, though, the site does not include results from CT scans or pathology reports that might indicate cancer.
PatientSite is "exemplary," said Pat Rutherford, vice president of the nonprofit Institute for Healthcare Improvement in Boston. "Information in the patient's chart, including medical test results, isn't ours, it's the patient's. Yet, historically, we've treated patients as if we are giving them a window on our work, as opposed to us having a window on their life."
Other medical systems are following suit, to varying degrees. Harvard Vanguard Medical Associates has a system called MyChart that allows patients to see test results after their doctor has reviewed them. Partners' system, PatientGateway, does not yet allow patients to see test results.
With mammograms, a highly anxiety-provoking test for many women, hospitals vary in how fast they communicate results to women. At Massachusetts General Hospital, radiologists try to get reports out within 24 hours to two days, admittedly "a long time, psychologically," said Dr. Daniel Kopans, director of breast imaging. But that time is necessary, he said, to enable two radiologists to read each X-ray for maximum accuracy.
Faulkner Hospital's breast imaging and diagnostic center gives women same-day results, and has both a radiologist and a computer scan each X-ray, said Dr. Norman Sadowsky.
To be sure, some waiting is inevitable because of biology, not bureaucracy. To ascertain what virus or bacteria has invaded a patient's system, for instance, lab technicians must grow the germs in cell culture, which can take several days. PAP tests for cervical cancer can take weeks because the test, which involves an expert looking carefully at slides under the microscope, is so labor-intensive.
In many ways, uncertainty is "the worst disease in the world," said Dr. Tom Delbanco, a general internist at Beth Israel. "The not-knowing can be worse than knowing the worst."
So what can you do? Be direct. While your doctor is talking to you about ordering the test, come right out and say, "I'm really nervous about this, but I don't want to be a pest. What's the best way to stay in touch with you? And what should I do if that doesn't work?" For the longer run, I humbly offer my own partial solution: Why not give patients a tracking number for each test, as UPS does for packages? At the very least, a patient could log on and see whether a test has gotten lost and when it's reasonable to bug the doctor for the answer.
Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.
