Why no news may not be good news when it comes to medical followups

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Why no news may not be good news when it comes to medical followups

When it comes to following up with patients on their test results, the regulatory body for physicians and surgeons in B.C. doesn't have a step-by-step process for doctors to follow.

Instead, health officials are responsible for creating their own systems for notifying patients.

Earlier this week, CBC News detailed the story of a B.C. woman who claims her husband died after a miscommunication between medical professionals.

Shannon Nolting alleges she and her husband, Eric, weren't notified of biopsy results that showed he had cancer until five years after the test. Eric eventually died of the disease and his wife is suing medical professionals for negligence.

Last year, another CBC News investigation revealed it took 11 months for a hospital in Vancouver to tell a woman a suspicious nodule had been spotted on one of her lungs.

Jenny Reiderman was ultimately diagnosed with lung cancer, which had spread since her initial X-ray.

Nolting's biopsy was done at a walk-in clinic, while Reiderman's X-rays were taken by an emergency room doctor. Neither had a family doctor at the time of their tests.

In a statement of defence, Interior Health said Nolting "unreasonably failed" to follow up on the biopsy himself. 

The emergency room physician who took Reiderman's X-ray wrote the patient a letter of response, admitting there were "pitfalls in the overall system."

That case — and others — have raised questions for health care patients in B.C.: who is primarily responsible for follow-up and how can patients be proactive?

Who's responsible?

Any physician who orders a test for a patient is responsible ensuring a follow-up system is in place, according to guidelines from the College for Physicians and Surgeons of B.C. (CPSBC).

If the referring physician can't pass on the results themselves, they'll need to take steps to be sure another doctor does.

When it comes to critical reports, any doctor who hears about those results is obligated to take steps to tell a patient in a timely manner — regardless of whether that person is no longer, or never was, in their care.

What does doctor follow-up look like? 

UBC clinical associate professor of medicine Dr. Michael Curry said most doctors in B.C. take similar steps when it comes to follow up, despite the lack of regulation.

Once a test has been done:

- The report is sent to the ordering physician by fax, mail or electronically.

- Doctors sort through results they receive to determine which need follow-up.

- Physician phones patient, then sends a letter if calls don't get through.

- Report is sent to the family doctor, if possible, after repeated attempts at contact fail.

But Curry said things can go wrong: faxes may not go through, phone numbers may be out of date, names could be misspelled — the doctor said the list goes on.

The best "safety net" Curry recommended would be a family physician.

"All those weird, one-off things are all vulnerabilities — particularly to patients that only have one doctor," he said. "It's really important to have a backup."

He did note that there's been a shortage of family doctors in the province due to an aging population, retirement, immigration and poor health.

The provincial government estimated 200,000 people in B.C. were without a family doctor in 2013.

Can I call about results?

Curry said patients should schedule their own follow-up appointments.

"With big health issues, patients should take ownership." he said. "The system is pretty good at follow up, but it's not perfect."

Susan Prins, the CPSBCs director of communications, recommended the same.

"'No news is good news' is not considered acceptable practice," she told CBC News in an email.

Medical malpractice lawyer Paul McGivern pointed out that The Canadian Medical Protective Association  — a not-for-profit that provides risk education for physicians — has also warned that the 'no news/good news' principle should be avoided.

What about checking online?

In B.C., you can register with my ehealth if you've had a lab test within the last 30 days at certain labs or hospitals. Find out which ones by clicking here.

In a statement, the B.C. Ministry of Health said it's implementing new tools for doctors across the province to bring faster healthcare to patients.