Dermatologists weigh benefits, drawbacks of patients' direct access to lab results

November 1, 2011

The Department of Health and Human Services is proposing a new rule that would allow patients to have direct access to their lab test results. The tests that dermatologists send, such as biopsies, can indicate serious medical conditions. On Call asked dermatologists around the country what they think about patients being able to access their lab results directly, without the benefit of the physician's knowledge and experience to interpret their meaning.

Key Points

The tests that dermatologists send, such as biopsies, can indicate serious medical conditions. On Call asked dermatologists around the country what they think about patients being able to access their lab results directly, without the benefit of the physician's knowledge and experience to interpret their meaning. We also talked to dermatologists who live in states where that access is already allowed, and we asked them how they are handling that process.

Fraught with problems

"On the surface, to a nonmedical person or layperson, it might seem like a good idea, but I think it's fraught with potential complications," he says. "The importance of any given lab results may vary from person to person, and it's necessary for a physician or other qualified medical provider to interpret the meaning of the results in the context of each patient.

"A patient may, without proper understanding of why we order certain tests, get results and be overly concerned about something that really isn't as important to their situation," Dr. Hearth says. "Perhaps more importantly, based on what they read, they may think the results indicate that everything's OK and neglect follow-up recommendations that their healthcare provider would advise. They may neglect follow-up thinking everything is OK when that may not be the case."

Internet issues

In Columbus, Ohio, Alan, J. Parks, M.D., shares those concerns. "There are so many diagnoses, especially when you're looking at pathology reports that aren't explainable to patients just in words. If they get on their computer, the Internet can be a dangerous thing. So they become very apprehensive about something that may not be that serious of a problem.

"For instance, if someone had a melanoma in situ, the prognosis is certainly different than if they have a full-blown melanoma," Dr. Parks says. "There might be a lot more anxiety than would really be necessary if they were to see that diagnosis on their own. There are too many things in dermatology that are followed by the word 'tumor,' but are benign. This could create unnecessary apprehension."

Do it yourself

Dr. Hersh says she prefers that system. "I think patients getting the results before we contact them would be confusing. It's better if we can call them and we can interpret the results for them, because otherwise what happens is that patients get upset and worry. Then they get on the Internet and the next thing you know, they're interpreting their own tests."

With 30 years of experience, Dr. Hersh says she knows that patients can have a tendency to misunderstand or jump to the worst possible conclusion.

"We tell people they have a basal cell and they think melanoma," she says. "But we can describe different basal cells in different scenarios and tell them there's nothing to worry about; we can take it off, and they feel so much better. If they just hear it's a tumor, they don't know, they're upset and immediately they want an MRI.

"It's too much medical information," she says. "I don't think they have to have that at their fingertips, and we certainly give them the information but we can help them through it."