SHIFT: Shouldn't we choose how we get news from our doctors?

There are very few things in life that are surprise-worthy — and test results aren’t one of them.

Lisa Machado 5 minute read November 1, 2021
mouth screaming

Communicating with your doctor the way you want to can go a long way to improving health outcomes. GETTY

“I won’t make you wait, let’s talk about the results…”

This is what my doctor says every time I have a test. It’s taken many years, but he has finally come around to the fact that calling a patient to tell them they have to wait for an appointment to discuss test results is far from ideal.

We have a long history of diagnostic procedures, he and I — unfortunately for me. Over the years, there have been little things, like tests for strep throat and allergies, but also big things like the time I found a lump in my breast. And sure, I admit that I might be a little more on edge than others when it comes to my health — when you live with a serious disease, you’re always waiting for the other shoe to drop, no matter how well things are going. So when the office receptionist calls to tell me that I won’t know the verdict of a test until I meet with the doctor in person, I’m going to freak out a little. And I’m not the only one.

When it comes to health, it’s really, really hard to wait.

why would they need to see me if the news is good? a friend texted, after getting a call from her doctor’s office about a recent Pap test. She added five emojis — three with wide eyes and two with tears.

What if it’s cancer? Maybe it’s just an infection.

What if I have to have more tests that hurt? Yikes .. surgery?

I should’ve made the appt sooner

I think I am getting pain now … in my ovaries. Or maybe it’s my cervix. Can you have belly button cancer?

Her mind was put at ease eight anxiety-filled days later when she finally saw her doctor. Turns out there were no results — the sample was inconclusive so she needed another Pap test. A simple do-over was a far cry from the gazillion potential death scenarios that had filled her mind in the days leading up to the big reveal.

hate hate hate surprises, she texted from the clinic waiting room. they coulda just told me. so glad I spent the last two days envisioning what my funeral would look like.

Frankly, there are very few things in life that are surprise-worthy — and test results aren’t one of them. The not-knowing is just too difficult.

“Sometimes, I think doctors forget what it’s like to be a patient,” said a work colleague when I shared a story about one of my neighbours who had a check-up recently that was completely unremarkable, except for a slight blip in her bloodwork. There were many possibilities for the blip, from something as harmless as a cold, to something more ominous, so it was good she was referred to a specialist as a precaution. What wasn’t so great was the doctor’s advice.

“I wouldn’t tell your family,” was all he said. In hindsight, he probably meant, ‘There’s no reason to worry at this point, so don’t bother mentioning it.’ But with no clarification, my neighbour took his statement to mean, “It could be something bad, so don’t worry your family.” And so began many hours of angst and sleepless nights, for her and her family (who she told), as she waited for another test. The results, by the way, were normal.

Clearly, there seems to be an issue with the way healthcare providers choose to communicate and share information with patients. Or is the problem instead that we, as patients, don’t ask for better?

Certainly, the pandemic has shown us the ease of virtual care, which, for many doctors, has meant online curbside consults and healthcare-by-phone. Using technology to connect is not new — pre-pandemic, many of us already had access to our health records through portals, while others managed appointment scheduling and test results through automated email messages.

And while technology allows us to access diagnoses without having to wait for an appointment, this is not without peril — ask anyone who has logged into their patient account or opened their email inbox late on a Friday night to read words like metastatic, malignant, or abnormal. Not knowing is hard, but knowing can be hell, especially when you are forced to sit with scary news for days — months, even — without the ability to ask questions, have worries soothed or make treatment plans.

Is it too much to ask for the information we need to be delivered clearly, when it’s available, with access to an expert who can help us navigate the news?

Dr. Quyen Ngo-Metzger raised this issue in the American Family Physician Journal, asking colleagues to weigh in on his opinion that it was okay to deliver test results by phone — especially in cases where the patient wants to know immediately, and is experiencing anxiety — rather than waiting for an in-person appointment.

“Despite conventional wisdom, I do not think it is intrinsically wrong to give a diagnosis over the phone; in fact, my patients have been grateful for it,” he writes.

The response to Ngo-Metzger’s comment, written by Dr.Caroline Wellbery, called in-person appointments “preferable,” especially if the news is bad, noting that many physicians have patients book follow-up appointments to discuss test results. “This practice protocol allows patients to know when they can expect to get the results and ask questions,” she writes, and helps the physician make time for discussion.

Wellbery does, however, concede the virtues of conveying news as soon as possible in cases where that treatment has to be started immediately (like a sexually transmitted infection), when the patient is unable to attend the next appointment, or when there is concern around results.

“In this age of instant messaging and e-mailing, asking patients to wait to come into the office to know their diagnosis may be unacceptable and may cause unbearable anxiety,” Wellbery writes. “Even with a grim diagnosis, patients often prefer to know right away than to have to wait to get their diagnosis in person.”

Thankfully, for my friend with the issue with her bloodwork, the specialist was part of a rapid response team and discussed the negative result an hour after her test. My Pap friend, however, is once again waiting worryingly for an appointment next month.

what if … 

This story originally appeared in the Healthing Weekender. Subscribe here