Take charge of your medical tests

Dec 20 2010

Whether you're healthy or ill, there are a variety of medical tests your health care team might recommend for you. A yearly checkup often includes routine tests such as blood sugar and cholesterol levels, vision and hearing assessments, tests for heart functioning and others used to monitor a chronic condition—such as a lung function test for those with asthma.

You may also be tested to diagnose or confirm the presence of a disease, or to see how well a particular treatment or medication is working.

But if the wrong test is given, or you fail to receive or understand your results, tests can work against your health. In a 2008 study of testing errors, researchers found that nearly three out of four patients involved in a testing error had their treatment delayed, or suffered additional pain, or had a worse health outcome as a result of the error.

Every time your team orders a test for you, the results become part of your medical history and a potential guide or reference for your future care. But many patients walk away from their doctor's office with important, unanswered questions:

•What tests will I take?
•Why have these tests been ordered?
•What will the tests show?
•What should I do after the test results are in?

Deborah Lewis got the shock of her life when a nurse from her pain management clinic called about the results from a recent MRI test.

"They told me I needed to see an oncologist right away, that I had tumors on my spine," the 46-year-old jewelry designer recalls.

Lewis made an appointment with an oncologist, "who couldn't understand why I was there," she says. "He went ahead and did a lot of tests even though he said the MRI report didn't indicate anywhere that I had tumors or cancer." Lewis says she and her husband "didn't know what questions to ask, or enough to even ask to see the report."

Lewis didn't have cancer, just benign tumors common to her diagnosis of spinal stenosis, a painful narrowing of the spinal column. "After a lot of wasted money, time and a whole lot of fear, we learned to question all test results," she says.

Every time your health care team orders a test, you should ask what the test will show, why the test has been ordered, and when you should expect to see the results. And if you don't understand the answers, don't be afraid to ask again, says Dennis Novak, M.D., a general internist and associate dean of medical education at Drexel University College of Medicine.

"It's always OK to ask about stuff you didn't understand," Novak said. "If you get tests and walk out without getting your questions answered, that's a problem."

In the exam room, you often get a lot of information that might be hard to remember later. You can request that your doctor take a minute to write down details like: 'the name of that test for me, please' or 'Exactly what condition(s) is this test trying to uncover?' It is also fine to ask about recommended resources to help you: 'Do you have any written materials that describe how I can prepare or what I should expect during this test?' or 'Can you recommend a Web site, or someone to call for more information?'

"I do my best to let my patients know when tests are routine versus more in-depth," says Peter Osterbauer, M.D., an Alaska neurologist. "For people with a potentially serious or life-threatening diagnosis, I strongly recommend that a dedicated appointment is made with their physician to discuss which tests are recommended, the potential risks and benefits of these tests and how the test results will affect further treatment decisions."

Haralee Weintraub, a women's clothing entrepreneur who was diagnosed with breast cancer eight years ago, used information on how her test results compared to others to decide on a medication after chemotherapy and radiation. Although the recommended drug "statistically would increase my lifespan [by] about 7 percent, I had horrible bone aches...and thought it was not worth it to me to be miserable," she recalls. "The doctor explained the risks and the tests, and at the end, it was my choice."

There is one issue doctors rarely if ever discuss: How much does the test cost? Before you agree to a test, increasingly you must put on a "health consumer" hat. Does your insurance cover the test, and even if so, what are your out-of-pocket costs? In an emerging trend, some employers now expect workers to spend more of their own money on medical services that they consider overused or less than valuable.

Once you've taken the test, follow-up is essential. And it's one place where mistakes happen often, according to researchers. For instance, in a 2007 study of California primary care doctors, about 20 percent of patients didn't get timely or appropriate notification of their abnormal test results.

The lesson? Never accept that "no news is good news," says Davis Liu, M.D., a family physician in Sacramento, Calif. "Always request that you see your test results, good or bad." You should also be sure that you know how you will be notified about the results, how long you should wait for the results and who you should call to follow up after receiving the results.

Be aware, Osterbauer says, that some kinds of tests can take longer than others. "Accuracy can be affected if the processing or interpretation of test results is hurried," he says. "For example, a pathologist could quickly glance at a tissue sample under a microscope and miss important findings."

Your health care office may ask how you would like to receive your test results, since some offices now deliver routine test results through an automated phone or e-mail system. If you're offered a choice of how to receive the results, the test is routine and the result is normal, this style of delivery might work for you. But if your tests are for a special condition, or if the results are unclear or not labeled "normal," you should insist that your health care team discuss the results with you in person.

What's Next?

You have your test results in hand—so what's next?

"Tests results in and of themselves don't describe what's happening to a patient," warns Lawrence Gordon, M.D., a New York ear, nose and throat doctor. "The result itself isn't as significant as what it means to the patient, and what it means to his or her doctor."

After the results come in, it's time to talk about what the tests show and what they might mean for your ongoing care. Even if it's a routine test like a cholesterol check, your health care team should go over the results with you and discuss what further measures—from medication to watchful waiting to another test—might be necessary.

One way to start the conversation, suggests cancer survivor Haralee Weintraub, is to ask what the "normal" test results would be, and ask your doctor to talk about where your results fall in comparison. After you understand how you compare, it can be easier to talk with your doctor about what steps you might take next.

If you're someone who sees multiple physicians, including specialists, you should have these discussions with the health care worker who ordered the test, according to Dr. Gordon. "Most tests try to answer a particular question, and the doctor ordering it is in the best position to initially interpret the results," he notes. But if you've had a test ordered by a specialist, he adds, you should still share those results with your primary care team.

Another critical task that often falls on patients these days: getting their test results to all the doctors who need to see them. Arranging this takes time and commitment, but it's often the only way to make sure your results don't fall through the cracks.

Take Charge of Your Tests

You can't order your own tests, and you may not be able to interpret them without the help of your health care team. But your test results are vital to your health, so it's important to do what you can to ensure that they are useful to you.

Persistence can be key, as Christy Johnson found out. The 27-year-old woman from Birmingham, Ala., undergoes regular testing for Graves disease, a thyroid disorder. For six months, she never saw a result, even though "every time I go for a visit, they have me address an envelope to myself so they can send me my labs," she wrote on her treatment blog, Life With Graves.

Johnson asked everyone in her doctor's office for results, but got no response until her doctor jotted down the results on the back of—you guessed it—a patient lab envelope. She finally received the official results by enlisting the help of a patient advocate at the testing hospital.

"The doctor asked me why I wanted to see the results," she recalled. "'Because I am trying to be very proactive about my health,'" she told him, "'and I can't do that if you don't provide me with the information I need to do that.'"

SOURCE Health Behavior News Service