The Cures Act signed into law in 2016 by then President Obama included many provisions. One was medical test results must be available for patients to review without delay. While doctors and patients universally think this is a desirable outcome, The New York Times found reasons to criticize it.
Its intention was to bring health care into the modern era. And the provision has successfully given patients easy access to their medical records, empowering them to play a more active role in their care by eliminating the doctor as gatekeeper.
But it has also led to experiences like mine, in which patients are confronted with material they never wanted to see. Some have learned about life-altering diagnoses and developments — from cancer to chronic illness to miscarriage — through emails and online portals, left to process the information alone.
Apparently bad and good news has to be delivered by a doctor (or his/her proxies) to be compassionate. Granted, there are times when you may prefer to hear bad news delivered by the doctor with some context.
“When information is just given in black-and-white type on MyChart, that’s not the full expression of compassionate care,” said Dr. Elizabeth Comen, an oncologist at Memorial Sloan Kettering Cancer Center in New York City. “Yes, it is immediate care, but it’s care out of context.”
I have ordered a battery of blood chemistry and urinalysis exams every year for the past 10 years whether I see my doctor or not. I keep the results and hand them to the doctor when I come in. This has worked pretty well and has saved me from tests ordered in the office where they’re more expensive. I recall getting a slightly out of bounds result on a urinalysis and scheduling a doctor’s appointment to review it. The doctor assured me it was nothing. A little context is always desirable when reviewing medical test results but patients have numerous resources other than to call the doctor. Patients often never heard back if the result was not out of the ordinary.
Before the Cures Act provision, doctors had different approaches to giving patients their test results. Some offices would contact patients within hours or days; others sent paper results via mail. Some would take a “no news is good news” approach, sharing results only if they revealed something worrisome; others waited to share results in person.
We own both a horse and a dog as companion animals. They both have seen numerous different veterinarians at different times for various conditions. Sometime the vet changes when one moves or changes employers. We always request copies of any lab results, notes, x-rays, etc. and keep them in our files. Sometimes veterinary offices are reluctant until we pester them enough. They don’t understand why we don’t just let them be the only depository for the records from that vet visit. Why? Because our dog has seen the same veterinarian at three different practices where she worked and she has since moved on to a fourth. Our last annual vet visit was with a new vet that we didn’t care for. We may bite the bullet and take our dog to her old vet who now works 60 miles away.
A horse is something of a money pit if cared for correctly. We requested copies of x-rays taken during her prepurchase examination and have copies of all x-rays since then. We have had the vet review old x-rays to compare with new ones. If we didn’t retain copies of all these files they would be scattered across multiple states at multiple veterinary practices. The same is true about our own doctor visits. If I see a new doctor for something I don’t necessarily want him or her to have to chase down records from five years ago.