Balancing risks and benefits

DIGITAL reporting means it is now easier than ever for GPs to gain quick access to hospital test results. This development undoubtedly brings benefits for patients as doctors are able to make diagnoses and carry out treatment more quickly. But there are also some associated risks.

Consider the following scenario:

A GP registrar, Dr F, is in consultation with an elderly patient, Mr B. He recently attended the local hospital to undergo a CT brain scan having suffered headaches and a fall in the previous months. Dr F can see how worried Mr B is about his health and she is keen to reassure him. She accesses the results of the CT scan and reads the report. She then informs Mr B that there appear to be “abnormalities”, although she admits to being “unqualified to read the report” and feels that specialist input is required to interpret the findings. She advises Mr B that the practice will contact the hospital consultant by letter for more information and get back to him in due course.

Two days later the practice receives a letter of complaint from the patient. Upon leaving the practice after the consultation, Mr B had suffered a panic attack on the way home. After receiving assistance from a neighbour, he was helped by his daughter to contact the hospital later that day. A consultant phoned back and reassured the patient that the result was fine and that the abnormalities reported are nothing to be concerned about.

Mr B is relieved by this but remains very unhappy about the unnecessary stress that Dr F placed on him and wants an apology.

Better and timelier access to information about patient testing and reporting may lead a doctor, with an anxious patient in front of them, to review results which would not previously have been accessible. In many cases, viewing such reports could ease the patient’s worry – particularly in areas where discharge information and reporting to the GP practice is routinely slow.

However, in our experience at MDDUS this can sometimes prove counter-productive. As illustrated in the scenario above, highlighting a potential “abnormality” to a patient when you do not have the appropriate knowledge or skills to fully interpret and explain the test results can serve more to increase anxiety rather than reassure.

In such situations, it is important to pause and consider the best course of action to ensure that you work within the limits of your competence. Of course, if you have an anxious patient or one whose condition has significantly deteriorated since they were last seen at hospital, you might judge that action is required.

In its guidance The Trainee Doctor, the General Medical Council clearly states: “Trainees must be appropriately supervised according to their experience and competence, and must only undertake appropriate tasks in which they are competent or are learning to be competent, and with adequate supervision. Trainees must never be put in a situation where they are asked to work beyond the limits of their competence without appropriate support and supervision from a clinical supervisor.”

In situations where you are dealing with specialist reports it may be more circumspect to inform the patient that you will investigate the matter and agree with them the most appropriate mechanism by which you will get back in touch, once you have further information. This will allow you more time to discuss the matter with a senior colleague or your trainer.

If you feel the patient’s symptoms have worsened and you have a higher index of suspicion, consider asking the patient to leave the room before looking online for any available results. This will give you the opportunity to review the report in private, allowing you to manage your uncertainty away from the patient. Taking this time to pause before discussing results with the patient will not trouble them – they will see that you are trying your best to resolve the situation for them and it can allow you to discuss the matter with a senior colleague or your trainer, or with a member of the hospital team if you feel further advice is required.

In summary, the next time you are confronted by a concerned patient awaiting test results, stop to consider the consequences of accessing data which may require specialist interpretation. Consider how the situation might be managed most effectively in relation to both accessing the result and managing the patient’s expectations and anxiety. It may be better to await specialist input – either in-house or from the hospital team concerned – before providing specific comment on the results to the patient unless you feel the benefits of this might outweigh the risks.

Liz Price is a senior risk adviser at MDDUS