Francesa Caller I Dont Need You to Review My Show

Recently I  read an article in the New York Times past Elisabeth Rosenthal. She's the aforementioned author of the enlightening commodity, "My doctor charged me $117,000 and all I got was this lousy hospital gown." That may not have been the exact title of the article.

Following that commodity she wrote a follow-up nearly the long and difficult ordeal it was to obtain medical records for the original article,  and how silly this seems in this modern technology age. Indeed, if Netflix can beam movies direct to your Google glass, why wouldn't health care providers and facilities be able get them to you about as quickly.

She asks a profound and important question that requires a nuanced, intelligent, well researched answer. This she did non non provide.  Instead she, in my opinion,  callously and cynically took the depression road in positing that physicians are money grubbing, greedy bastards who hoard the medical records of their patients in social club to keep them coming dorsum. Furthermore, she states, nosotros do so while hiding backside a feigned wall of privacy concerns.

Ms. Rosenthal makes these bold statements on the basis that they must be factual because a Harvard Constabulary professor told her and then.

And who knows more most medicine than lawyers, right?

I tin can't speak for all physicians, but I do know that in every profession in that location are bad, greedy people who do things for the incorrect reasons. I also know that near of the physicians I know don't wake up in the morning thinking virtually how they can make money by not giving people their test results. And while transparency is a good thing, but giving results to patients without any context can exist fraught with run a risk.

I take seen cases where patients have gotten their test results direct and lead to unnecessary tests. One individual had benign lymph node enlargements, which were confirmed by a biopsy. However,  the person had a follow-up scan ordered by another physician, which was interpreted past a different radiologist who interpreted the follow-up scan as "malignancy tin not be excluded."  They eventually went to another medico and demanded another biopsy that was unnecessary, and, of course, all the same benign.

Beyond the practical argument for not straight providing people with their medical exam results there are fiscal reasons likewise. And while some may refer to this as greed, remember that physicians are businesses, who await off-white or fifty-fifty less than fair payment for rendered services. While in that location are a few insurance companies who will pay a physician for their time in making phone calls to their patients, the vast majority (including Medicare) reimburse physicians on a "fee for service" basis. Thus, they volition but pay for face to face services on insured patients.  In effect, past relaying results over the phone, I would non only be providing a free service, I would, in fact, be coming out behind. This is because of the fact that in the time it takes me give out sage medical advice for complimentary, I could accept been seeing some other patient.

If and when test results are to be provided to patients, it's important that they be provided in the proper context. Test results should exist discussed earlier they are ordered so that patients know what to wait. In my practice, simple blood test results can be viewed by patients through an electronic portal. If somebody wants their entire medical history at my practice, this can usually be provided to them inside 1 to ii business days.

While providing routine blood work tests don't require much context, other test results are more than complicated. How I handle biopsy and browse results is a different process that has evolved over time. Most people who have just been diagnosed with lung cancer, for example need to accept a face to face conversation. Post-obit the news of a new diagnosis of lung cancer  there are tears, acrimony, and questions. What's the next step? Chemo? Radiation? Surgery? Am I going to die? This takes the fourth dimension and skill of a practitioner who knows and understands not just the science of the diagnosis, but an understanding of how to navigate the complicated medical maze that comes afterwards.

In her article, Ms. Rosenthal refers to the case of a man who had to return to their doctors office to go results of an MRI which turned out to be negative (apparently the good news that he did non need surgery did not first the acrimony at having to pay for some other office visit)

If I were to take this approach, I would then be calling all people with negative biopsies. It wouldn't be long before people found out that no call from the doctor means that something really bad is happening.  It is simply more expedient to say that any testing with potentially far-reaching implications (similar surgery) should come in for a follow-up visit. This is ane of the reasons why patients with sure medical tests are asked to come in for results, and this is what I try to explain to them when I ask the question of why tests simply tin can not be sent to them.

That's not to say that people don't effort to circumvent the system. After explaining my policy to a patient who was undergoing a lung biopsy, her family called and demanded the results without an office visit. They finally called their primary doc's office and establish a sympathetic receptionist who agreed to forward a copy of a "lung biopsy" report. They were relieved to discover that the biopsy report showed benign tissue.

She did not come in for her office follow up with me, which was concerning, because while one of her lung biopsy samples was negative, there were other parts of the procedure which the pathologist took longer to study.

I chosen the family and spoke with the daughter and family and explained how sorry I was that they had received results that were incomplete. Their mother did indeed have cancer. She yelled in disbelief "but I got the results, they were negative! How can you at present tell me that she has cancer?" I explained that the pathologist wanted to perform boosted stains and cell typing on other samples that we took. This meant that these results took longer to written report than the initial tissue results that were negative.  Her atheism turned to sorrow and shock, as information technology often does when one learns of this diagnosis. She began to cry, as I heard other family members who were listening around the room on speaker do the same.

Transparency is good, and equally both a  purveyor of medical technology and as a preacher of the merits of social media, I look forward to the increasing openness of medical information. But at that place are lots of ways to save money, lots of things to inexpensive out on, and lots of middlemen that tin be removed from medicine. Your physician is not ane of them.

Deep Ramachandran is a pulmonary and critical care doc, and social media co-editor, Chest. He blogs at CaduceusBlog and ACCP Thought Leaders, and can be reached on Twitter @Caduceusblogger.

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Source: https://www.kevinmd.com/2015/07/theres-a-good-reason-why-doctors-dont-send-test-results.html

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