Why doesn’t my doctor just call me with my results? 

Sometimes, a phone call to touch base with a patient with results is the right thing to do.  And doctors do.  But what do doctors think about before just picking up the phone to you? There must be a reason besides wanting to schedule extra appointments (because, let’s be honest, doctor’s aren’t looking for business – have you tried to get an appointment anywhere lately?!)  While I certainly don’t have the all the answers! – here’s some of the challenges that doctors and patients face in a busy healthcare system.

Before I pick up the phone, here are just some of the things that I think about: 

• Patient privacy (Were is the patient or who are they with?)

• The other patients waiting (Will I have time to answer all of the patient’s questions now?)

• Is a quick phone call the right way to have this discussion (I know that the patient will need to make some decisions, and this shouldn’t be rushed on a phone call.)

• Do I have enough time? Remember, the phone calll doesn’t end for the doctor after you hang up.   Afterwards, your doctor still has to record the phone call in your medical notes, and maybe do whatever was agreed on:  email a prescription or write a letter or fill out a form.

Patients, correctly, often ask:  “Don’t I have a right to my information?” Well, yes, of course! That’s actually the point: You have the right to receive you results WITH correct interpretation and psychological/emotional support and to have all your questions answered (Like: “what does that mean for me?” “What do we do next?” “That wasn’t what I was expecting!!”  “since we last talked, I was just thinking…”) without resorting to Dr. Google or a night of fretful anxiety until the doc can slot you in the next day.  The current practice of immediate, unfiltered patient results uploaded instantly to view in patient portals n USA healthcare systems has come under criticism for just that:  Imagine seeing in imaging result in your portal suggesting cancer at 5pm on a Friday evening.

That said, like many doctors, I usually expect to see patients back for a short consultation – either in person or virtual –  with results from any test we’ve requested.  Because it’s not just about the results of any investigation: it’s to make a plan of care based on those results, fundamental to the process of “Shared Decision Making”.  Short, secure telehealth appointments at a pre-arranged time (the patient knows s/he will have privacy) are appropriate.  But they are still consultations:  I have to have my room empty for privacy.  After we end the conversation, even if it is 5 minutes, I still have to write what happened for your medical records and may need to do other work on your behalf:  write and email a prescription, write a short letter to your GP, enter that all into your patient chart.

When I set up direct care model in my current practice, it was hard to find the balance:  I want patients to have access to results, but I don’t want the situation where incomplete information could lead to needless worry or anxiety.  My patients all have access to a secure patient portal where they can see results or copies of their letters.  However, I make sure that anything that is viewable in that portal is something that I have discussed with the patient already. I also avoid cold-calling patients if at all possible, in the interest of their privacy.  They shouldn’t feel they need to take a call from me at the school gates or on a crowded DART.  A quick email or a text to schedule a short virtual consultation (when both of us are in private and have a few minutes),

It’s worth noting that many very good GPs argue that they do not want to discuss specialist investigation results with patients that were ordered by a consultant. For example, when I order an investigation for a patient and, for whatever reason, the patient does not attend for results/follow-up, I will send a copy of results and a letter to the GP. It is not unusual to get a letter back, correctly stating that it is best for me to discuss results with the patient and they will do their best to urge their patient to re-schedule with me when next they see them.

For everyone else, getting the most out of your appointment with your GP or consultant/specialist? Yes, doctors are much too busy in the current doctor-shortage, but here are some tips to help you build a good working relationship with your GP or consultant. It’s that important.

• Turn Off Your Phone when you are with your doctor.
• Prepare for your appointment by writing down all your questions. I tell this to all of my patients, whether it is GP appointment, awaiting an in-hospital consult, or meeting with Public Health Nurse. You will forget that one thing you meant to ask. Bring the list, and don’t leave before making sure you asked everything. I recently wrote how much I hate – and love – the list, but it does work.
• If you are given a recommendation for a scan, new medication, or told something you don’t understand: ASK! Before you leave the room, pause and make sure you are completely happy with the information before you leave. Your doctor would much rather make sure you have the right information for YOU, rather than Dr. Google’s answer. When you get home, and you find your forgot to ask or aren’t clear, ring the surgery and ask the receptionist to have the GP ring you back at his earliest convenience. Have your question ready. If it is more than just a simple question to clarify a point, be prepared that you might need to come back in if it requires a discussion (remember, someone else is waiting on your doctor in the waiting room and your GP also has out-of-hour on-call duties many nights).

• If you know you will need time: to have an in-depth discussion about social issues, have more than one child that you need seen, etc., be honest when booking the appointment. Many will try allocate you more time, or maybe put you at the end of the day.

•If you are returning for test results and very anxious or need to discuss something very troubling, consider bringing someone with you.  Choose someone who you would feel would help you feel calm and supported.   It is is not always appropriate, but it is no harm in asking.

• Questions about the new prescription after leaving? Your best bet is your chemist/pharmacist. Ask to speak to the chemist/pharmacist himself/herself (not the sales clerk). Pharmacists are amazing and highly trained. All of us docs in every type of practice rely on them to advise us on medications, doses, side effects, and interactions – that’s what they are there for!

• Feel your doctors isn’t listening? Say it (kindly!) in the moment. Doctors are human, and most Irish docs have too many patients, a lot of HSE stress, and are constantly under-resourced. It probably isn’t you. Just give them a gentle nudge to re-focus on your concern. Don’t just leave the appointment and get online.

• Interested in alternative therapies, holistic treatments, etc.? Do discuss it with your doctor. Some essential oils DO have clinical evidence, others can actually interact with your prescription medication, some are just rubbish.

• Try not be personally offended by suggestions of lifestyle change. It’s your doctor’s ethical and professional obligation to bring up when relevant, health risks of lifestyle choices: smoking, alcohol/drug misuse, bike helmets.  Some of these discussions are awkward, and sometimes your doctor might get the tone wrong or misstep. It’s okay to let them know that you aren’t ready for that discussion at the moment.