LAB TESTING AND RESULTS
HOW TO GET YOUR LAB RESULTS
- You will be called if there are any urgent issues that need to be dealt with, otherwise you will receive your results by mail or by using MyChart, but only if you have previously registered on MyChart.
- Remember: “No news is good news” can be a fatal assumption......so if you don't hear about your results within 4 weeks, PLEASE CALL OR EMAIL. Always best to check on this especially if you are concerned.
- Advice about preparation for having screening blood testing done:
- You should be fasting for 10 hours before blood is drawn to give you "true" readings for cholesterol levels (lipid profile) or if a fasting blood sugar is needed to rule out diabetes. Drink as much water as you want and take your usual medications.
- Avoid heavy exercise for 24 hours before lab work. This can cause elevation in certain muscle and liver enzyme levels and thereby avoiding unnecessary repeating of studies and further work up. I would suggest the same for alcohol and excessive Tylenol / acetoaminophen use which can elevate liver enzymes. In men sexual activity can also raise PSA levels.
- I always tell patients that if additional testing is needed to never ever accept the phrase, “we’ll only contact you if the results are bad.” What if a doctor never sees the results because of misfiled paperwork or a laboratory mix-up? What if a doctor and/or their office never got the results and never contacted you? You were told not to worry unless someone called. So who pays the ultimate price for this oversight? You do.
- I re-emphasize that "no news means no news". The news could be good or bad, and you won’t know unless you are contacted with the results. So, if any additional testing is needed, you should always expect to get the results. They can be communicated to you through a simple letter, email or phone call from the office staff. Call or email our office if you don’t hear from us in a reasonable amount of time. It is always better to double check and be safe than sorry..
What does that blood test mean?
CBC or complete blood count checks your white cells, red cells and platelets. This test is helpful to establish whether you have an infection or are anemic.
C8, Chem 8 or basic metabolic profile checks your kidney (renal) function: BUN, creatinine and estimated GFR/glomerular filtration rate; electrolytes: Na/sodium, K/potassium, Cl/chloride, bicarbonate; calcium and sugar (glucose)
Lipid or cholesterol profile measures and breaks down the cholesterol into total, HDL (good), LDL (bad), triglyceride level and risk ratio. Ideally you should be fasting for this test.
Hepatic panel, LFT or liver function tests checks your bilirubin (for jaundice) and enzyme levels
TSH or thyroid stimulating hormone checks your thyroid gland for under/hypo or over activity/hyper.
ESR or erythrocyte sedimentation rate is a nonspecific test and may be helpful in determining whether you have an infection or inflammation
CRP or C reactive protein is also a marker for inflammation
Uric acid determines whether you are at risk for gout
PSA or prostate specific antigen is a test which may in some be helpful in screening for prostate cancer
HgbA1C, hemoglobin A1c or glycohemoglobin level is a measure of your average daily blood glucose/sugar over the past 8 weeks. No fasting is necessary for this test.
More details.......
Glucose: This is the chief source of energy for all living organisms. A level greater than 110 in someone who has fasted for 12 hours suggests a diabetic tendency. The strict definition of diabetes which is a level greater than 125.
Sodium: This element plays an important role in salt and water balance in your body. A low level in the blood can be caused by too much water intake, heart failure, or kidney failure. A low level can also be caused by loss of sodium in diarrhea, fluid or vomiting. A high level can be caused by too much intake of salt or by not enough intake of water.
Potassium and Magnesium: These elements are found primarily inside the cells of the body. Low levels in the blood may indicate severe diarrhea, alcoholism, or excessive use of water pills. A very low level of magnesium in the blood can cause your muscles to tremble. Low potassium levels can cause muscle weakness and heart problems.
Chloride: Is an electrolyte controlled by the kidneys and can sometimes be affected by diet. An electrolyte is involved in maintaining acid-base balance and helps to regulate blood volume and artery pressure. Elevated levels are related to acidosis as well as too much water crossing the cell membrane.
BUN (Blood Urea Nitrogen): BUN is a waste product derived from protein breakdown in the liver. Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise, heart failure or decreased digestive enzyme production by the pancreas. Decreased levels are most commonly due to inadequate protein intake, malabsorption, or liver damage.
Creatinine: Creatinine is also a protein breakdown product. Its level is a reflection of the bodies muscle mass. Low levels are commonly seen in inadequate protein intake, liver disease, kidney damage or pregnancy. Elevated levels are generally reflective of kidney damage and need to be monitored very carefully.
Uric Acid: Uric acid is the end product purine metabolism. High levels are seen in gout, infections, high protein diets, and kidney disease. Low levels generally indicate protein and molybdenum (trace mineral) deficiency, liver damage or an overly acid kidney.
Phosphate: Phosphate is closely associated with calcium in bone development. Therefore most of the phosphate in the body is found in the bones. But the phosphate level in the blood is very important for muscle and nerve function. Very low levels of phosphate in the blood can be associated with starvation or malnutrition and this can lead to muscle weakness. High levels in the blood are usually associated with kidney disease. However the blood must be drawn carefully as improper handling may falsely increase the reading.
Calcium: Calcium is the most abundant mineral in the body. It is involved in bone metabolism, protein absorption, fat transfer, muscular contraction, transmission of nerve impulses, blood clotting, and heart function. It is highly sensitive to elements such as magnesium, iron, and phosphorous as well as hormonal activity, vitamin D levels, CO2 levels and many drugs. Diet, or even the presence of calcium in the diet has a lot to do with "calcium balance" - how much calcium you take in and how much you lose from your body.
Albumin: The most abundant protein in the blood, it is made in the liver and is an antioxidant that protects your tissues from free radicals. It binds waste products, toxins and dangerous drugs that might damage the body. Is also is a major buffer in the body and plays a role in controlling the precise amount of water in our tissues. It serves to transport vitamins, minerals and hormones. The higher this number is, the better. The highest one can reasonably expect would be 5.5.
Alkaline Phosphatase: Alkaline phosphatase is an enzyme that is found in all body tissue, but the most important sites are bone, liver, bile ducts and the gut. A high level of alkaline phosphatase in your blood may indicate bone, liver or bile duct disease. Certain drugs may also cause high levels. Growing children, because of bone growth, normally have a higher level than adults do. Low levels indicate low functioning adrenal glands, protein deficiency, malnutrition or more commonly, a deficiency in zinc.
Transaminases (SGTP) & (SGOT): These are enzymes that are primarily found in the liver. Drinking too much alcohol, certain drugs, liver disease and bile duct disease can cause high levels in the blood. Hepatitis is another problem that can raise these levels. Low levels of GGTP may indicate a magnesium deficiency. Low levels of SGPT and SGOT may indicate deficiency of vitamin B6.
Gamma-Glutamyltranserase (GGTP): Believed to be involved in the transport of amino acids into cells as well as glutathione metabolism. Found in the liver and will rise with alcohol use, liver disease, or excess magnesium. Decreased levels can be found in hypothyroidism and more commonly decreased magnesium levels.
Lactate Dehydrogenase (LDH): LDH is an enzyme found in all tissues in the body. A high level in the blood can result from a number of different diseases. Also, slightly elevated levels in the blood are common and usually do not indicate disease. The most common sources of LDH are the heart, liver, muscles, and red blood cells.
Total Protein: This is a measure of the total amount of protein in your blood. A low or high total protein does not indicate a specific disease, but it does indicate that some additional tests may be required to determine if there is a problem.
Iron: The body must have iron to make hemoglobin and to help transfer oxygen to the muscle. If the body is low in iron, all body cells, particularly muscles in adults and brain cells in children, do not function up to par. If this test is low you should consider getting a Ferritin test, especially if you are a female who still has menstrual cycles.
Triglycerides: These are fats used as fuel by the body, and as an energy source for metabolism. Increased levels are almost always a sign of too much carbohydrate intake. Decreased levels are seen in hyperthyroidism, malnutrition and malabsorption.
Cholesterol: Group of fats vital to cell membranes, nerve fibers and bile salts, and a necessary precursor for the sex hormones. High levels indicate diet high in carbohydrates/sugars. Low levels indicate low fat diet, malabsorption, or carbohydrate sensitivity.
HDL/LDL: LDL is the "bad cholesterol", which carries cholesterol for cell building needs, but leaves behind any excess on artery walls and in tissues. HDL is the "good cholesterol" which helps to prevent narrowing of the artery walls by removing the excess cholesterol and transporting it to the liver for excretion. A low HDL percentage frequently indicates diets high in refined carbohydrates and/or carbohydrate sensitivity.
CO2: The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally, when used with the other electrolytes, carbon dioxide levels indicate pH or acid/alkaline balance in the tissues. This is one of the most important tests that we measure. Most people have too much acid in their body. If you garden you will know that it is very difficult to grow plants in soil where the pH is incorrect. Our blood is similar to soil in many respects and it will be difficult to be healthy if our body's pH is not well balanced.
WBC: White blood count measures the total number of white blood cells in a given volume of blood. Since WBCs kill bacteria, this count is a measure of the body's response to infection.
Hemoglobin: Hemoglobin provides the main transport of oxygen and carbon in the blood. It is composed of "globin", a group of amino acids that form a protein and "heme", which contains iron. It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption.
Hematocrit: Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), dehydration (elevated) or possible overhydration (decreased).
MCV: This measures the average size of the red blood cells and their volume. These components together can indicate iron deficiency anemia (decreased), B12/folate deficiency anemia, under active thyroid, alcohol excess (increased), or rheumatoid arthritis (decreased).
Results and what they mean......
Lab test results may be positive, negative, or inconclusive. Your doctor will discuss what your test results mean for you and your health.
What are false-positive and false-negative test results?
A false-positive test result is one that shows a disease or condition is present when it is not present. A false-positive test result may suggest that a person has the disease or condition when he or she does not have it. For example, a false-positive pregnancy test result would appear to detect the substance that confirms pregnancy, when in reality the woman is not pregnant.
A false-negative test result is one that does not detect what is being tested for even though it is present. A false-negative test result may suggest that a person does not have a disease or condition being tested for when he or she does have it. For example, a false-negative pregnancy test result would be one that does not detect the substance that confirms pregnancy, when the woman really is pregnant.
Some lab tests can give you specific information. For example, your doctor may suspect you have strep throat and order a throat culture to see if streptococcus bacteria are present. A positive lab test confirms that you have strep throat and helps your doctor choose the right treatment for you.
But some tests give only a clue that must be considered with other information to support a diagnosis, identify a risk, or help choose a treatment. For example, your doctor uses your cholesterol levels plus other things, such as blood pressure and age, to check your risk of a heart attack.
What if your results are different than the reference range?
It is possible to have a result that is different than the reference range even though nothing is wrong with you. Sometimes certain factors can affect your test results, such as pregnancy, a medicine you are taking, eating right before a test, smoking, or being under stress.
When your lab numbers are lower or higher than the numbers in the reference range, further testing may be needed. Your doctor may want to repeat the test or order another test to confirm the results.
Why do values or reference ranges vary from lab to lab?
Labs may use different types of equipment and tests, and sometimes they set their own reference ranges. Your lab report will contain the reference ranges your lab uses. Do not compare results from different labs.
Only a handful of tests, such as blood sugar, have standardized reference ranges that all labs use. This means that no matter where these tests are done, the results are compared to the same reference ranges.
CBC or complete blood count checks your white cells, red cells and platelets. This test is helpful to establish whether you have an infection or are anemic.
C8, Chem 8 or basic metabolic profile checks your kidney (renal) function: BUN, creatinine and estimated GFR/glomerular filtration rate; electrolytes: Na/sodium, K/potassium, Cl/chloride, bicarbonate; calcium and sugar (glucose)
Lipid or cholesterol profile measures and breaks down the cholesterol into total, HDL (good), LDL (bad), triglyceride level and risk ratio. Ideally you should be fasting for this test.
Hepatic panel, LFT or liver function tests checks your bilirubin (for jaundice) and enzyme levels
TSH or thyroid stimulating hormone checks your thyroid gland for under/hypo or over activity/hyper.
ESR or erythrocyte sedimentation rate is a nonspecific test and may be helpful in determining whether you have an infection or inflammation
CRP or C reactive protein is also a marker for inflammation
Uric acid determines whether you are at risk for gout
PSA or prostate specific antigen is a test which may in some be helpful in screening for prostate cancer
HgbA1C, hemoglobin A1c or glycohemoglobin level is a measure of your average daily blood glucose/sugar over the past 8 weeks. No fasting is necessary for this test.
More details.......
Glucose: This is the chief source of energy for all living organisms. A level greater than 110 in someone who has fasted for 12 hours suggests a diabetic tendency. The strict definition of diabetes which is a level greater than 125.
Sodium: This element plays an important role in salt and water balance in your body. A low level in the blood can be caused by too much water intake, heart failure, or kidney failure. A low level can also be caused by loss of sodium in diarrhea, fluid or vomiting. A high level can be caused by too much intake of salt or by not enough intake of water.
Potassium and Magnesium: These elements are found primarily inside the cells of the body. Low levels in the blood may indicate severe diarrhea, alcoholism, or excessive use of water pills. A very low level of magnesium in the blood can cause your muscles to tremble. Low potassium levels can cause muscle weakness and heart problems.
Chloride: Is an electrolyte controlled by the kidneys and can sometimes be affected by diet. An electrolyte is involved in maintaining acid-base balance and helps to regulate blood volume and artery pressure. Elevated levels are related to acidosis as well as too much water crossing the cell membrane.
BUN (Blood Urea Nitrogen): BUN is a waste product derived from protein breakdown in the liver. Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise, heart failure or decreased digestive enzyme production by the pancreas. Decreased levels are most commonly due to inadequate protein intake, malabsorption, or liver damage.
Creatinine: Creatinine is also a protein breakdown product. Its level is a reflection of the bodies muscle mass. Low levels are commonly seen in inadequate protein intake, liver disease, kidney damage or pregnancy. Elevated levels are generally reflective of kidney damage and need to be monitored very carefully.
Uric Acid: Uric acid is the end product purine metabolism. High levels are seen in gout, infections, high protein diets, and kidney disease. Low levels generally indicate protein and molybdenum (trace mineral) deficiency, liver damage or an overly acid kidney.
Phosphate: Phosphate is closely associated with calcium in bone development. Therefore most of the phosphate in the body is found in the bones. But the phosphate level in the blood is very important for muscle and nerve function. Very low levels of phosphate in the blood can be associated with starvation or malnutrition and this can lead to muscle weakness. High levels in the blood are usually associated with kidney disease. However the blood must be drawn carefully as improper handling may falsely increase the reading.
Calcium: Calcium is the most abundant mineral in the body. It is involved in bone metabolism, protein absorption, fat transfer, muscular contraction, transmission of nerve impulses, blood clotting, and heart function. It is highly sensitive to elements such as magnesium, iron, and phosphorous as well as hormonal activity, vitamin D levels, CO2 levels and many drugs. Diet, or even the presence of calcium in the diet has a lot to do with "calcium balance" - how much calcium you take in and how much you lose from your body.
Albumin: The most abundant protein in the blood, it is made in the liver and is an antioxidant that protects your tissues from free radicals. It binds waste products, toxins and dangerous drugs that might damage the body. Is also is a major buffer in the body and plays a role in controlling the precise amount of water in our tissues. It serves to transport vitamins, minerals and hormones. The higher this number is, the better. The highest one can reasonably expect would be 5.5.
Alkaline Phosphatase: Alkaline phosphatase is an enzyme that is found in all body tissue, but the most important sites are bone, liver, bile ducts and the gut. A high level of alkaline phosphatase in your blood may indicate bone, liver or bile duct disease. Certain drugs may also cause high levels. Growing children, because of bone growth, normally have a higher level than adults do. Low levels indicate low functioning adrenal glands, protein deficiency, malnutrition or more commonly, a deficiency in zinc.
Transaminases (SGTP) & (SGOT): These are enzymes that are primarily found in the liver. Drinking too much alcohol, certain drugs, liver disease and bile duct disease can cause high levels in the blood. Hepatitis is another problem that can raise these levels. Low levels of GGTP may indicate a magnesium deficiency. Low levels of SGPT and SGOT may indicate deficiency of vitamin B6.
Gamma-Glutamyltranserase (GGTP): Believed to be involved in the transport of amino acids into cells as well as glutathione metabolism. Found in the liver and will rise with alcohol use, liver disease, or excess magnesium. Decreased levels can be found in hypothyroidism and more commonly decreased magnesium levels.
Lactate Dehydrogenase (LDH): LDH is an enzyme found in all tissues in the body. A high level in the blood can result from a number of different diseases. Also, slightly elevated levels in the blood are common and usually do not indicate disease. The most common sources of LDH are the heart, liver, muscles, and red blood cells.
Total Protein: This is a measure of the total amount of protein in your blood. A low or high total protein does not indicate a specific disease, but it does indicate that some additional tests may be required to determine if there is a problem.
Iron: The body must have iron to make hemoglobin and to help transfer oxygen to the muscle. If the body is low in iron, all body cells, particularly muscles in adults and brain cells in children, do not function up to par. If this test is low you should consider getting a Ferritin test, especially if you are a female who still has menstrual cycles.
Triglycerides: These are fats used as fuel by the body, and as an energy source for metabolism. Increased levels are almost always a sign of too much carbohydrate intake. Decreased levels are seen in hyperthyroidism, malnutrition and malabsorption.
Cholesterol: Group of fats vital to cell membranes, nerve fibers and bile salts, and a necessary precursor for the sex hormones. High levels indicate diet high in carbohydrates/sugars. Low levels indicate low fat diet, malabsorption, or carbohydrate sensitivity.
HDL/LDL: LDL is the "bad cholesterol", which carries cholesterol for cell building needs, but leaves behind any excess on artery walls and in tissues. HDL is the "good cholesterol" which helps to prevent narrowing of the artery walls by removing the excess cholesterol and transporting it to the liver for excretion. A low HDL percentage frequently indicates diets high in refined carbohydrates and/or carbohydrate sensitivity.
CO2: The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally, when used with the other electrolytes, carbon dioxide levels indicate pH or acid/alkaline balance in the tissues. This is one of the most important tests that we measure. Most people have too much acid in their body. If you garden you will know that it is very difficult to grow plants in soil where the pH is incorrect. Our blood is similar to soil in many respects and it will be difficult to be healthy if our body's pH is not well balanced.
WBC: White blood count measures the total number of white blood cells in a given volume of blood. Since WBCs kill bacteria, this count is a measure of the body's response to infection.
Hemoglobin: Hemoglobin provides the main transport of oxygen and carbon in the blood. It is composed of "globin", a group of amino acids that form a protein and "heme", which contains iron. It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption.
Hematocrit: Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), dehydration (elevated) or possible overhydration (decreased).
MCV: This measures the average size of the red blood cells and their volume. These components together can indicate iron deficiency anemia (decreased), B12/folate deficiency anemia, under active thyroid, alcohol excess (increased), or rheumatoid arthritis (decreased).
Results and what they mean......
Lab test results may be positive, negative, or inconclusive. Your doctor will discuss what your test results mean for you and your health.
- A positive test result means that the substance or condition being tested for was found. Positive test results also can mean that the amount of a substance being tested for is higher or lower than normal.
- A negative test result means that the substance or condition being tested for was not found. Negative results can also mean that the substance being tested for was present in a normal amount.
- Inconclusive test results are those that are not clearly positive or negative. For example, some tests measure the level of antibodies to some bacteria or viruses in blood or other bodily fluid to look for an infection. It is not always clear if the level of antibodies is high enough to indicate an infection.
What are false-positive and false-negative test results?
A false-positive test result is one that shows a disease or condition is present when it is not present. A false-positive test result may suggest that a person has the disease or condition when he or she does not have it. For example, a false-positive pregnancy test result would appear to detect the substance that confirms pregnancy, when in reality the woman is not pregnant.
A false-negative test result is one that does not detect what is being tested for even though it is present. A false-negative test result may suggest that a person does not have a disease or condition being tested for when he or she does have it. For example, a false-negative pregnancy test result would be one that does not detect the substance that confirms pregnancy, when the woman really is pregnant.
Some lab tests can give you specific information. For example, your doctor may suspect you have strep throat and order a throat culture to see if streptococcus bacteria are present. A positive lab test confirms that you have strep throat and helps your doctor choose the right treatment for you.
But some tests give only a clue that must be considered with other information to support a diagnosis, identify a risk, or help choose a treatment. For example, your doctor uses your cholesterol levels plus other things, such as blood pressure and age, to check your risk of a heart attack.
What if your results are different than the reference range?
It is possible to have a result that is different than the reference range even though nothing is wrong with you. Sometimes certain factors can affect your test results, such as pregnancy, a medicine you are taking, eating right before a test, smoking, or being under stress.
When your lab numbers are lower or higher than the numbers in the reference range, further testing may be needed. Your doctor may want to repeat the test or order another test to confirm the results.
Why do values or reference ranges vary from lab to lab?
Labs may use different types of equipment and tests, and sometimes they set their own reference ranges. Your lab report will contain the reference ranges your lab uses. Do not compare results from different labs.
Only a handful of tests, such as blood sugar, have standardized reference ranges that all labs use. This means that no matter where these tests are done, the results are compared to the same reference ranges.
The Anxiety of Waiting for Test Results
By Jan Hoffman : NY Times : July 23, 2012
After MaryAnn and Drew Szilagyi, a Houston couple in their early 30s, saw their physician for routine physicals a few years ago, they didn't have to wait for his call about the blood work. Just two days later, Mr. Szilagyi, a banker, logged onto a Web site, perused his lab results and sighed with relief. All normal.
But when Mrs. Szilagyi, who sells luxury kitchen equipment, followed suit, no results were displayed. Instead, a message flashed: Contact Doctor's Office.
Her internal alarms began clanging.
That day she left four messages for her doctor. No response. The next day, Mrs. Szilagyi, who has a family history of breast cancer, pleaded with the receptionist for help. She pulled Mrs. Szilagyi's chart and said, "I can't tell you what it says, but I don't think you should worry."
Now angry as well as frightened, Mrs. Szilagyi continued to worry. On the third day, the doctor's nurse reached her. What result had caused so much mystery and misery?
Mrs. Szilagyi, it turned out, had a vitamin D deficiency.
"All that stress over getting some more sun and eating better," said Mrs. Szilagyi, now 35.
The excruciating limbo that follows significant medical tests is a nearly universal experience for patients. Doctors do not always ease patients' anxiety, delivering bad news matter-of-factly, failing to call swiftly, even losing results altogether.
As medical records move online and state regulations loosen, many patients can bypass the doctor's call and get the results of these tests faster, directly from labs via Web sites and apps. But new federal regulations may permit all patients that right by year's end. Many experts are concerned that pervasive direct access to test results may have serious drawbacks, leaving patients even more confused and overwhelmed by information they do not know how to interpret.
According to the Centers for Disease Control and Prevention, about 6.8 billion laboratory tests were performed in the United States in 2007. At that time, more than 4,000 diagnostic tests were available and 1,420 diseases could be detected with genetic testing.
The impact of waiting for test results on patient anxiety is significant. It has been studied in breast cancer biopsy patients, infertility patients and patients undergoing genetic testing, among others. Stress alone, these studies show, can affect recovery time and exacerbate side effects from medications. The psychological toll in households can also be harsh, especially among family members with clashing coping styles - if, say, one person has an optimistic bent, while the other tends to presume the worst.
In an exploratory study at the Wake Forest Baptist Medical Center in Winston-Salem, N.C., published this spring in The Journal of the American College of Radiology, more than 80 percent of patients said they would rather have online access to such results within three days, no matter how dense the jargon, than wait a week or longer for a doctor's interpretation. By the end of September, the medical center's patients will be able to directly access their test results three days after physicians sign off and, in some cases, even sooner.
"Once you know what you have, you can make plans," said Dr. Elvira V. Lang, a radiologist who taught at Harvard Medical School and has studied the effect of stress on cortisol levels in patients waiting for biopsy results. Until then, she said, you may imagine the worst, "but you can't map the next step."
While some results are now available within hours, many high-stakes tests, involving growing cultures or tissue dissection, still require days, even weeks. And according to Dr. Hardeep Singh, who wrote about direct access to test results last December in The Journal of the American Medical Association, physicians themselves do not always give patients results in a timely manner.
Dr. Singh, who leads the health quality program at the Houston Veterans Affairs Research Center of Excellence, said in an interview that several studies have shown that doctors delay or fail to notify patients of as many as 36 percent of abnormal test results, including possible malignancies.
There are many reasons, he said, chief among them the lack of reliable tracking systems to follow up the hundreds of results that a busy physician typically receives in a week.
Since 2003, patients have been entitled to receive medical records from doctors, hospitals and health plans within 30 days of their request. Clinical labs, which perform most tests and are required to report to the physicians, were the exception.
Seven states permit labs to release reports directly to patients, seven states allow such reporting with physician approval, and 23 states are silent on the issue. Thirteen states mandate that labs report only to physicians. But potential changes under review to federal health privacy regulations would allow all patients to request results directly from labs, which would have 30 days to comply.
Would quicker, direct access reduce anxiety? Or, without a medical professional offering context and explanation, could it provoke greater anxiety or even false assurance?
Dr. Jason Poston, an associate fellow at the Bucksbaum Institute for Clinical Excellence at the University of Chicago Medical Center, has mixed feelings about direct access.
"It's empowering for patients," Dr. Poston said. "But anything abnormal shows up red and bold. Some of those results may be due to chance. Some of them are not suggestive that you have a disease. So you run the risk of anxiety either with too little or delayed information, or with free access to all the information, because it can overwhelm you."
The variety and complexity of tests continue to grow. Many do lead to critical interventions. But others merely point to statistical possibilities, opening doors to further testing or to the gray universe of "watchful waiting." These results often require a subtle, sophisticated interpretation that may be far beyond the average patient's first reading.
Many experts argue that if patients are to have direct access to test results, doctors and labs should ensure that patients are also provided with information to help them understand the shorthand numbers - and that doctors themselves follow up promptly.
Dr. Poston, an intensive care specialist, teaches medical students to begin educating patients about results even before the test is done. Patients should have realistic expectations about what results may or may not reveal, he tells students, and why some tests still take time to be analyzed. Not only will patient anxiety be somewhat alleviated, Dr. Poston said, but the role of the doctor as critical guide and partner in the patient's care will be reinforced - even as a patient's need to participate in decision-making will be supported.
Informed, calmer patients, Dr. Poston added, are more likely to comply with tests, surgery and medication, increasing the likelihood of better outcomes. But a doctor needs time to assess the patient's psychological needs - and doctors can't bill for hand-holding. "How do we come to a system where we can do right by the patient and also make the practice financially viable?" Dr. Poston said.
Mrs. Szilagyi, the Houston woman who had the stress-strafed episode with online results, also went through two difficult pregnancies. Those times, she did not have direct access to results, which were given to her, and carefully translated, by a genetics counselor.
Her divergent experiences offer a window onto the new and the traditional means of learning vital medical information.
During her first pregnancy, at 31, she had a routine first-trimester ultrasound and blood work. The screen revealed that the pregnancy was in the abnormal range: Her baby's chances of having Down syndrome were 1 in 191. Jennifer M. Hoskovec, director of prenatal genetic counseling services at the University of Texas Medical School at Houston, met with Mrs. Szilagyi, who chose to have an amniocentesis, knowing that the procedure could pose a small risk to the fetus.
Mrs. Szilagyi had to wait two weeks for the procedure and two more for results. She was a wreck, enduring migraines and eating little. Mrs. Hoskovec would check in. Although she tried to contain Mrs. Szilagyi's worries by offering evenhanded information, she did not dismiss her anxiety as overblown. "Pregnancy is stressful," she told Mrs. Szilagyi. Worry and fear are normal.
Finally Mrs. Hoskovec called with good news: Their baby boy was fine. That first screen was a false positive.
But during her second pregnancy, Mrs. Szilagyi's first-trimester tests also came back with abnormal results. Mrs. Szilagyi again had an amniocentesis.
Mrs. Hoskovec called with results. In some fetal cells, a small piece on chromosome 10 was missing. The variation could be normal, she said, but it could also suggest a risk.
In her 18th week, Mrs. Szilagyi had a second amniocentesis. "I had so much worry and guilt," she recalled. "My husband was O.K. with the odds. I wasn't, and who did I think I was to play God, to need to know what was going to occur? And what could I have just done to this baby?"
At last Mrs. Hoskovec phoned. The Szilagyis were on schedule to deliver a healthy girl.
In Texas, where the Szilagyis live, patients can get access to lab results if the physician concurs. But that restriction will disappear if the revised federal regulations take effect, most likely later this year.
Across the country, patients and providers will have to decide how to manage the new rights. Will the responsibility for learning results begin to shift from doctor to patient? How will doctors ensure that patients understand what they have read online? How will doctors manage the heavy traffic of panicky phone calls?
Few argue, in theory, with the notion that patients should have faster access to test results. But after waiting for more test results than she cares to remember, Mrs. Szilagyi believes sometimes an expert's interpretation is more important than instant answers.
"If you had normal labs from a basic screen, going online is great because it cuts down waiting time," she said.
If she had read the results of the second pregnancy's amnio online? "I would have been devastated," she said, adding that Mrs. Hoskovec had been invaluable.
"I needed Jen, with her knowledge and expertise, to get me through."
A Little Preparation, a Lot of Coping
As patients wait for test results, anxiety rises as time slips into slow motion. But experts say patients can regain a sense of control.
- Start before the test itself.
- Because fear can cloud memory during talks with doctors, take notes. If you can, bring a friend to catch details you may miss.
- What precisely can this test reveal? What are its limitations?
- How long should results take, and why? Will the doctor call with results, or should I contact the office?
- If it's my responsibility to call, what is the best time, and whom should I ask for?
- What is the doctor's advice about getting results online?
The four-alarm worriers may also hold tight to magical thinking: If they can stare, unblinking, into the abyss of worst-case scenarios, maybe the abyss will blink first - and the news will be good.
"Is that worry working for you?" Dr. Montgomery said he tells patients. "If you need a day to cry, fine, but if it's incapacitating you, we need to find another way."
Experts also say patients should recall strategies they've found useful in other stressful situations. Suggestions include self-hypnosis and yoga. Many patients find comfort in prayer.
Others keep busy to avoid ruminating. Many stave off feeling helpless by doing something helpful for someone else. Or they combat anxiety by doing activities they enjoy. (Power-shopping, anyone?)
For patients who find anxiety crippling, some recommend medication. Dr. Elvira V. Lang, a radiologist who teaches medical professionals how to alleviate patients' stress, prefers that patients not go that route.
"Once you take the medication, you can't drive, operate machinery, prepare documents carefully," she said. "I urge patients to take deep breaths: taking in strength and letting go of whatever thoughts are not helpful."
Dr. Montgomery says mental toughness may be overrated. "People say, 'Suck it up!' " he said. But waiting for the results of an important medical test, he added, "is an out-of-ordinary experience, a significant life event. It's O.K. to ask for help."
When the Doctor’s Words Aren’t Soothing
By Jan Hoffman: NY Times : July 27, 2012
I used to be a confident patient. I did not worry that tests would turn out badly. Well into adulthood, I was always reasonably healthy.
But over time, loved ones, close friends - and I - got tripped up by episodes of ill health, some from the far end of the statistical-probability universe. The unthinkable became reality. We were vulnerable.
Soon enough, each new medical test triggered greater anxiety in me. By now, I have morphed into one of those four-alarm, full-blown worriers, a card-carrying member of the 3 a.m. e-mail club. What else to do at that dark hour, except to lie awake, fearing the bad news that dawn may bring?
A medical professional's manner can provoke or soothe my apprehension. The doctors I interviewed for my article in this week's Science Times, "The Anxiety of Waiting for Test Results," spoke of the scripts they teach medical students to help prepare patients who are waiting for test results. Please, kids, don't cut these classes.
Once, after major surgery, I groggily came to as a young resident tiptoed toward me, looking nervous. My preoperative Pap smear, he said, came back as severely abnormal.
What does that mean, I whispered?
"We'll have to do more tests," he said solemnly, "but you may have cervical cancer."
His timing was wrong; his delivery was wrong. As nurses changed my surgical dressings, I wept, terrified.
Weeks later, follow-up tests. Normal. No cervical cancer. Not even close.
As I've lain on tables for ultrasounds, I've had technicians stare at monitors, shake their heads and whisper - and look away. Except for the one who said, "Wow, you're just coming to us now? You mean you never felt that?"
But perhaps the prize for worst delivery goes to the doctor of a friend who was waiting for results of her young child's leukemia treatment.
On a Thursday afternoon before a long holiday weekend, the doctor left a voice mail message: "Hi! The results are in. They're still a little abnormal. We should talk. Call my office Monday morning to make an appointment."
But there have also been moments of grace. I will always remember another radiology technician, who, as I shook with fear after an M.R.I. scan, folded me in her arms, whispering prayers in my ear.
Once, after I'd had a biopsy, the doctor who performed it, a chilly stranger, refused to let my regular doctor tell me results. Her procedure, her phone call.
A nurse pulled me aside. "Don't worry," she said. "If she doesn't change her mind, I'll make sure your doctor sees your results first. At the very least, you deserve that much." That nurse kept her promise.
Finally, there was the unexpected turn of events following a miserable stretch of 10 days after a PET scan: metastatic cancer, yes or no? My oncologist promised to call immediately. He knows how I get.
By my calculation, I was likely to hear from him the following Thursday, sometime between 1:15 p.m. and 1:30 p.m.
But the day before the call was to come, I got a last-minute assignment. On that Thursday I would be in Atlanta, reporting for an article due Friday morning.
If my cellphone were to ring with a life-altering message, how could I concentrate?
Please, I begged the doctor's nurses and secretary, via e-mail, voice mail and direct calls: Ask him to postpone the call until Friday afternoon.
That Thursday I was in a kitchen in suburban Atlanta, conducting my interview, having compartmentalized my fear. Suddenly my cellphone buzzed. It was my doctor. I grew pale, but didn't answer.
The words of the person I was interviewing became lost in a wind tunnel. Shakily I excused myself and fled to a bathroom. I couldn't not listen to the voice message.
"Hi, it's Larry," my doctor said. "I got your messages. I know, I'm not supposed to call. Sorry to disappoint you. But I thought you'd like to know as soon as possible. Normal. The results are normal. Have a good day."
By Jan Hoffman: NY Times : July 27, 2012
I used to be a confident patient. I did not worry that tests would turn out badly. Well into adulthood, I was always reasonably healthy.
But over time, loved ones, close friends - and I - got tripped up by episodes of ill health, some from the far end of the statistical-probability universe. The unthinkable became reality. We were vulnerable.
Soon enough, each new medical test triggered greater anxiety in me. By now, I have morphed into one of those four-alarm, full-blown worriers, a card-carrying member of the 3 a.m. e-mail club. What else to do at that dark hour, except to lie awake, fearing the bad news that dawn may bring?
A medical professional's manner can provoke or soothe my apprehension. The doctors I interviewed for my article in this week's Science Times, "The Anxiety of Waiting for Test Results," spoke of the scripts they teach medical students to help prepare patients who are waiting for test results. Please, kids, don't cut these classes.
Once, after major surgery, I groggily came to as a young resident tiptoed toward me, looking nervous. My preoperative Pap smear, he said, came back as severely abnormal.
What does that mean, I whispered?
"We'll have to do more tests," he said solemnly, "but you may have cervical cancer."
His timing was wrong; his delivery was wrong. As nurses changed my surgical dressings, I wept, terrified.
Weeks later, follow-up tests. Normal. No cervical cancer. Not even close.
As I've lain on tables for ultrasounds, I've had technicians stare at monitors, shake their heads and whisper - and look away. Except for the one who said, "Wow, you're just coming to us now? You mean you never felt that?"
But perhaps the prize for worst delivery goes to the doctor of a friend who was waiting for results of her young child's leukemia treatment.
On a Thursday afternoon before a long holiday weekend, the doctor left a voice mail message: "Hi! The results are in. They're still a little abnormal. We should talk. Call my office Monday morning to make an appointment."
But there have also been moments of grace. I will always remember another radiology technician, who, as I shook with fear after an M.R.I. scan, folded me in her arms, whispering prayers in my ear.
Once, after I'd had a biopsy, the doctor who performed it, a chilly stranger, refused to let my regular doctor tell me results. Her procedure, her phone call.
A nurse pulled me aside. "Don't worry," she said. "If she doesn't change her mind, I'll make sure your doctor sees your results first. At the very least, you deserve that much." That nurse kept her promise.
Finally, there was the unexpected turn of events following a miserable stretch of 10 days after a PET scan: metastatic cancer, yes or no? My oncologist promised to call immediately. He knows how I get.
By my calculation, I was likely to hear from him the following Thursday, sometime between 1:15 p.m. and 1:30 p.m.
But the day before the call was to come, I got a last-minute assignment. On that Thursday I would be in Atlanta, reporting for an article due Friday morning.
If my cellphone were to ring with a life-altering message, how could I concentrate?
Please, I begged the doctor's nurses and secretary, via e-mail, voice mail and direct calls: Ask him to postpone the call until Friday afternoon.
That Thursday I was in a kitchen in suburban Atlanta, conducting my interview, having compartmentalized my fear. Suddenly my cellphone buzzed. It was my doctor. I grew pale, but didn't answer.
The words of the person I was interviewing became lost in a wind tunnel. Shakily I excused myself and fled to a bathroom. I couldn't not listen to the voice message.
"Hi, it's Larry," my doctor said. "I got your messages. I know, I'm not supposed to call. Sorry to disappoint you. But I thought you'd like to know as soon as possible. Normal. The results are normal. Have a good day."
Your Lab results
