is no news good news? i don't think so.

[Guest guest]

as far as i'm concerned, "no news is good news" is only appropriate in cases of kidnapping. my assistant keeps a folder containing copies of labs ordered and referrals made, and transfers the order or referral to the patient's folder once the report or consult comes back. at that point, the actual report or consult then resides in folder awaiting my review. after my review, i sign the report or consult electronically, and my assistant then carries out the following actions-- if a report or consult is normal, the patient is contacted and told the result, or asked to return, either sooner, or later, for follow-up, at an interval i determine. if action is required, the patient is contacted, and asked to return, again, either sooner or later, for follow-up, at an interval i determine. either way, i see everything, there is a means to make sure the appropriate

things have been ordered, i know if the patient followed through, and the patient knows that i am following what's happening with them. additionally, results of labs, with few exceptions, are automatically copied to the patient. if a patient chooses to not follow through with recommended labs or referral for consultation, i have a way of tracking that. my assistant then documents in their chart that they refused to follow up with recommended treatment. ditto for follow-up with me. i also let patients know that if they don't get lab orders or have their labs drawn or a referral wasn't made, to call the office and ask for it. i want patients to be involved in their care, and to help prevent breakdowns or delays in their care. there are a couple of potential breakdown points in my system; one is that i have to be sure that orders for labs and referrals are sent to my assistant; on occasion, i have

forgotten to do that; however with the new version of AC (3.2, not yet out), a reminder from within the encounter can be sent directly to my assistant's inbox. i also have to be sure that i review information in my "to be reviewed" folder. the lab interface in the new AC version will also help, since labs come directly into the lab "in-box", awaiting signature. the management of the flow of information is key to several things-- appropriate initial care relating to prevention, and acute and chronic conditions, and follow-up for same, which all comprise the centerpiece of a patient registry; keeping the patient involved, and return business, which relates to financial viability. hope that's helpful. LL Eads wrote: My main concern with that sort of system is that you need to have good tracking to make sure the lab result came in, not an easy feat to accomplish (even though we are supposed to), that I do, but with lots of effort. Having the patients expect a result from me helps to make sure I’ve gotten the results and passed them on. I’ve had many patients come from other practices where they were told ‘no news is

good news’ (ie, results are assumed to be normal if they are not called), when they actually had very abnormal results (enough to warrant further investigation/med change, etc) and were never contacted. I’ve had other patients that were not able to get their lab results, even though they wanted them, without becoming extreme pests (numerous calls to their doctor, writing letters, going in to the office to pick up the results, etc). I’ve found that most people appreciate the reassurance that their labs were indeed normal. Maybe difference in climates (malpractice, expectations, etc) between the US and Canada. I do know docs here that do exactly as you describe, but that is not ideal in my mind. My 2 cents worth. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of jeff_harriesSent: Monday, January 01, 2007 5:02 PMTo: Subject: Calling or e-mailing lab reports to patients - Does it provide true value? I practice in BC, Canada. I tell my patients I will only contact themwhen tests are abnormal. I believe this saves an enormous amount oftime. Most MD's in BC do it this way. We are paid about $24 US pervisit, by the way. Routinely contacting patients regarding normal values strikes me as awaste of time. I explain to the patients what I expect the tests willshow and give advice based on that. If results don't

support mypreliminary advice then I will call the patient, explain theunexpected results and adjust the advice.Would such a strategy work where you practice?Jeff HarriesPenticton, B.C. __________________________________________________