Handling Unsolicited Test Results
By Eric Zacharias, MD
SCENARIO A: Pre-existing physician-patient relationships
CASE STUDY
Your 47-year-old patient self-referred for a heart scan after his older brother had a myocardial infarction. You have taken care of this patient for at least 20 years and you last saw him three years ago for a routine physical exam that was unremarkable including normal labs. He also saw a cardiologist approximately five years prior to evaluate palpitations. The heart scan results revealed an Agatston score of over 300, placing the patient in the highest risk category for coronary heart disease and future myocardial infarction. Your office received a fax with the results from the walk-in heart scan clinic.
In this case, since there is an existing physician-patient relationship, you should assume responsibility for contacting the patient to discuss the meaning of the results and a plan of action. This could be an office appointment, a telehealth visit, or a phone conversation. Alternatively, you could refer the patient to the appropriate specialist for interpretation of the test result and determining the course of action, regardless of whether the patient self-referred for the test.
Additionally, you should not assume that the cardiologist who the patient saw before has either received the heart scan results or is acting upon them (even if the report explicitly states a copy is being sent there). Since you have direct knowledge of the at-risk test result, the best practice would be to follow up with the patient directly and not assume some other physician is following up.
Although the scenario would not warrant urgent evaluation, the test results do reveal potential risk factors for major adverse events such as heart attacks or strokes. Arranging for communication with the patient regarding results and next steps, even though you did not request the tests, ensures appropriate follow up occurs.
You may be in a physician-patient relationship that is not necessarily obvious. For example, accepting a capitated payment from a health plan on behalf of a patient may establish a physician-patient relationship regardless of whether you’ve actually seen that patient. You should be aware of this potential issue in your practice setting.
SCENARIO B: No established physician-patient relationship
If no relationship exists, you may choose whether or not to accept the patient into your practice:
If you accept the patient, first contact the patient and assume all the obligations of interpretation, monitoring, and follow-up of the diagnostic test.
If you choose not to enter into a physician-patient relationship, return the original test to its source or the diagnostic center responsible for it. If you do this, use a statement such as “This is not a patient in our practice. Please use your data to inform the patient for appropriate physician referral or follow-up.”
This action would also be appropriate if you receive tests results in error (e.g., by fax or mail). Calling the sender directly to notify them of the misdirected result has the best chance of getting the information to the patient and the proper provider for appropriate treatment and follow-up. Critical test results may require more diligence to ensure the information gets to the appropriate provider in a timely manner.
What should you do for documentation in this scenario?
Although there is no legal duty, in the interest of patient safety there are some suggested steps you should take in returning an unsolicited diagnostic test:
You should keep a log that documents the date the test was received, the patient’s name, the action taken in returning the test to the sender, and who the sender is.
It is recommended that you fax the test information back so you will have documentation that the information was faxed to the appropriate test source and received.
Eric Zacharias, MD, is with the COPIC Department of Patient Safety and Risk Management