The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.
THE QUESTION
My father died of melanoma. He'd had a biopsy two years earlier, but when he didn't receive a call from the surgeon's office he assumed no news was good news. We didn't know he had cancer until he was near the end. How can patients protect themselves?
THE ANSWER
This complaint illustrates the pitfall of the "no news is good news" practice in some doctors' offices. In this case, no news was devastating news that caused incalculable pain to the patient and family. While earlier knowledge of a biopsy finding might not necessarily have changed the course of this man's illness, it would have allowed his family to plan his last years. That was taken from him.
In a telephone interview from Edmonton, Trevor Theman, registrar of the College of Physicians and Surgeons of Alberta, offers this advice: "Don't think you can assume that there is a system (of managing test results) and that it's always going to work for you."
Alberta, Ontario, British Columbia and Quebec have policies to help prevent follow-up failures. Most regulatory bodies insist physicians have a system to ensure that every test result is reviewed before it is filed and the patient chart closed. They are expected to be particularly vigilant about cases in which the stakes are high.
Licensing bodies take a dim view of physicians who fail to manage test results properly, Dr. Theman says. Doctors are in "trouble if they don't have a system and we find out."
Even so, you shouldn't assume it's going to work flawlessly every time. Test results can fall through the cracks. A laboratory result could come in, be placed in a patient file by office staff, then forgotten. A result could get misplaced while the doctor is on vacation. A patient could be referred to another specialist who orders even more tests and it is not clear who is in charge of follow-up.
To prevent these problems from happening, create your own system. Before undergoing a test, ask your doctor the best way to learn the results. Suggest a telephone call to the doctor's office, or another appointment. In the case of a specialist, you need to find out if those results will be told to you or sent to your family physician, necessitating another appointment.
Patients have a right to know their test results, Dr. Theman says.
Being passive can be risky. And while you may not want to know every result of every test, particularly if it is unremarkable, patients should pay special attention to biopsies, blood work, diagnostic tests and mammogram findings.
"Never assume anything. I think it's really important for patients to be advocates for themselves," Dr. Theman says. "You should be asking questions."
After all, it's the patient - not the doctor - who pays the ultimate price for a test result that is misplaced or forgotten.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.