CALLING THE PATIENT WITH LAB RESULTS: A SECOND CHANCE TO REFLECT

A physician’s personal telephone call to the patient, to convey the results of a laboratory test, is one way to cement the physician-patient relationship. Not only is this a key step in involving the patient in managing his own health. But, merely thinking about and making the call helps the physician to focus on the importance of the test, itself.

After a six-year hiatus, a 61-year-old gentleman visited Dr. GP complaining of nausea after meals, as well as cramping and diarrhea. Dr. GP took a history of urinary frequency and nocturia, and learned that the patient’s father had died at age 85 of stomach cancer. Dr. GP ordered labs, advised a complete physical, and referred the patient to a gastroenterologist for his GI complaints.

Three months later, blood work showed a glucose level of 399, (normal 70-110) with 4+ glucose and 1+ ketones in the urine (both abnormal). Although it was Dr. GP’s office protocol to personally call patients with lab results, there was no record that Dr. GP made such a call, in this case.

Four months later, the patient returned for complete physical exam, following a sigmoidoscopy that was normal. Dr. GP’s impression at the time was hyperglycemia. He planned to have the patient do another fasting blood sugar and hemoglobin A1C test. Dr. GP gave the patient lab requisition slips, told him to watch his diet and to avoid sugar, and asked him to keep in touch.

Six months later, the patient fell, striking his head. An orthopedic surgeon ordered x-rays. When the patient returned to see Dr. GP, the patient was scheduled to see an ophthalmologist (who found some frontal nerve damage). Dr. GP’s records failed to note that the patient still had not undergone the lab tests recommended six months earlier. Next, Dr. GP examined the patient prior to prostate surgery. Again, the records made no mention of currents labs showing abnormal glucose level (386) and abnormal glucose and ketones in the urine.

Three months later, Dr. GP performed another work-up. This time, lab results showed the patient’s glucose at 451 and the AC1 at 11.5 (normal 4.6-6.5). Dr. GP’s attempt to reach the patient by phone was unsuccessful because he was out of town. When the patient called back, one of Dr. GP’s partner’s prescribed insulin and Glucovance over the phone. At his last visit to Dr. GP’s office, the patient saw another partner, and reported blurry vision for the past several months. As it turned out, the patient had developed diabetic retinopathy, as well as bilateral lower extremity diabetic neuropathy. He filed a claim against Dr. GP for failure to diagnose and treat diabetes, that was resolved prior to an arbitration hearing.

A personal call by Dr. GP to the patient after the initial labs would have given the patient the benefit of the physician’s thinking on the results, even if those tests did not yet confirm diabetes. But one can also wonder if making the call could also have benefited the physician: Might the mere acts of sitting down to consider the report, translating its meaning into layman’s English, and preparing for the patient’s questions, have prompted the physician to adopt a more aggressive plan?

Gordon Ownby is general counsel at CAP-MPT.Comments on Case of the Month should be directed to gownby@cap-mpt.com