Occasionally I get the odd phone call on
the duty biochemists desk from patients wishing to discuss results directly. A
few months back I was contacted by an extremely intelligent, elderly Greek
patient who had concerns about his renal function and was being monitored with
regular Creatinine measurements and estimated GFR. He religiously plotted these
results over time from appointments as a hospital out patient and those
measurements made from GP appointments. He couldn’t understand why the
results from the two locations were both stable across time but different,
resulting in two parallel lines on his graph. After some investigation it
transpired that the eGFR from the lab accounted for the methodological bias of
the Creatinine method, whereas the GP surgery was just taking the Creatinine
and calculating the eGFR by MDRD. The keen eye of this patient enabled this
simple discrepancy to be picked up, he also fully understood the concept of
method bias and the need for such “fiddle factors”. As
But that’s OK because we all know
bankers can be trusted to do the right thing don’t we.
BW John
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On
Behalf Of Elizabeth MacNamara
Sent: 10 November 2008 16:00
To:
[log in to unmask]
Subject: Re: Copy them in --
Richards 337 (43): a2324 -- BMJ
As someone trained in
Dear David
This topic will be considered at the Path
IT
Regards
Gifford
Professor Gifford Batstone
MBBS, BSc, FRCPath, MSc
-----Original
Message-----
From: Clinical biochemistry
discussion list [mailto:[log in to unmask]]
On Behalf Of David Hardy
Sent: 09 August 2008 17:35
To: [log in to unmask]
Subject: Re: Copy them in -- Richards
337 (43): a2324 -- BMJ
From my
experience as a patient, I would say "no"; results are not routinely
communicated (nor routinely any form of copied correspondence). That said, I
recently had some routine blood tests through occupational health at work and I
did get a copy of the results.
I think
there are two issues here. Firstly, not all patients will want the results.
Many (probably older) patients may still have a reverence for the medical
profession that means they would rather just trust them to do right by them.
Additionally we should be mindful that the average reading age in the
Secondly,
the patient that trawls the internet for any and all information relating to
their case, and then turns up in clinic arguing the toss, is not apocrypthal. A
little knowledge is a dangerous thing, and may make the patient more difficult
to relate to and treat.
I am not
saying it shouldn't be done. I think in some cases it could be really useful
and involve the patient more fully. In some cases, though, it could be
disasterous. Perhaps the real question is not whether they should be given
their results, but what will giving them the results achieve? The patient may
be involved in their diagnosis and treatment, but they cannot "take
ownership" of them; there is still an element of passivity in their situation.
I am also a little unsure about the issue of educating patients this way. In
terms of andragogy, adults learn when there is a reason to do so.
I would
posit that patients should be given results and their interpretation on a
selective basis.
Best
wishes,
Dave
Dr
David Hardy,
Senior Scientist,
Regulatory Clinical Pathology,
DSRD,
Pfizer Ltd,
CT13 9EU
Tel: 01304 640619
E-mail: [log in to unmask]
or [log in to unmask]
From: Clinical
biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Jonathan Kay
Sent: 09 November 2008 16:49
To: [log in to unmask]
Subject: Copy them in -- Richards
337 (43): a2324 -- BMJ
http://www.bmj.com/cgi/content/full/337/nov04_3/a2324
And should we not go further than routinely copying patients into correspondence? Why not extend this courtesy to the results of blood tests and other investigations? It’s disquieting to have no idea when, or even if, your test results will be relayed back to you. Doctors should not assume that patientswon’t understand them or don’t need to know if the results are normal. Although it’s time consuming to relay results and discuss any uncertainties and dilemmas they may raise, it’s a great way to promote learning among patients.
I know this is commonly
done in some other countries. Does anyone do this routinely in the
Should reports be
different in content or format if copied to patients?
Jonathan
------ACB discussion List
Information-------- This is an open discussion list for the academic and
clinical community working in clinical biochemistry. Please note, archived
messages are public and can be viewed via the internet. Views expressed are
those of the individual and they are responsible for all message content. ACB
Web Site http://www.acb.org.uk List
Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/
------ACB discussion List Information-------- This is
an open discussion list for the academic and clinical community working in
clinical biochemistry. Please note, archived messages are public and can be
viewed via the internet. Views expressed are those of the individual and they
are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/
------ACB discussion List Information-------- This is an open discussion list
for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet.
Views expressed are those of the individual and they are responsible for all
message content. ACB Web Site http://www.acb.org.uk
List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/