The anxious wait for results
Waiting for tests, and test results, 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 routine blood tests, he said, but X-rays, CT and MRI scans, the domain of radiologists.
Five years ago, delays in radiological testing were understandable -- a patient’s old films, used for comparison purposes, had to be retrieved physically from the files. “Now, most departments are digital, or could be if they chose. We have instant retrievability of prior images, so that is no longer an excuse,” said Forman. “A radiology report should be provided within 24 hours in 99% of cases.”
Moreover, voice recognition technology dramatically shortens the time it takes a radiologist to finalize a report. “A CT scan these days takes 15 minutes to do, an MRI might take 30 to 45,” said Dr. David Levin, former chairman of the radiology department at Thomas Jefferson University in Philadelphia.
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, computers process the radiologist’s voice as he or she looks at the image and create 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, said in an e-mail interview.
But things often bog down, partly from sheer volume. A study at Brigham and Women’s Hospital in Boston showed that the average primary care doctor gets 240 test results a day, though a complete blood work-up may include 20 tests, said John Glaser, vice president and chief information officer at the Partners HealthCare System, of which Brigham and Women’s is a member.
Technology has also provided other ways to shorten the time it takes to get results.
Beth Israel Deaconess Medical Center in Boston, for instance, has a Web-based system called PatientSite that allows patients to log on and in most cases, see 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 Institute for Healthcare Improvement, a nonprofit health organization 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. In California, the Palo Alto Medical Foundation system allows patients access to their electronic medical records through www.pamfonline.org, though for lab tests and radiology, the doctor always sees the report before it is made available to the patient, said Dr. Paul Tang, chief medical information officer.
With mammograms, a highly anxiety-provoking test for many women, hospitals vary in how fast they communicate results. 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.
The breast imaging and diagnostic center at Boston’s Faulkner Hospital 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 requires an expert to examine the slides under a microscope, is so labor-intensive. Flow cytometry on white blood cells to check for leukemia can take a day or two because cells have to be tagged and counted, said Dr. David Keren, a pathologist who heads the Warde Medical Laboratory in Ann Arbor, Mich.
And in some cases, waiting is necessary to give a patient time to respond to treatment. Dot Chainey, a 57-year-old painter who lives in Apple Valley, recently had to wait -- sleepless and anxious -- for a CT scan to see if a drug she took in September for her recurring non-Hodgkin’s lymphoma had worked.
“I can’t deal with it,” she said before the scan. “I’ve tried yoga, I’ve tried to distract myself as best as possible.... This is my life, waiting for the day to come for the CT scan.”
Finally, she learned that the cancer had shrunk, but not as much as she’d hoped. She’ll have another scan in a few months. In the meantime, she waits.
In many ways, this kind of 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.”
