Why would a cardiologist withhold test results?
April 25, 2021 12:09 AM Subscribe
My mom had a heart attack 4 weeks after a hip replacement surgery (which went very well - she's a very active and otherwise healthy 70 yr old, her PT was moving along at an impressive pace), she received 3 stents. Discharge was scheduled after 3 days, they ran some tests and extended her stay a day. On day 6 she still doesn't have any new info, not even the results of the tests they ran. I'm sure it's just precaution and thoroughness, given all the circumstances, but why might a doctor in the CICU withhold information from the patient and/or spouse?
It's very possible the doctor is just awful at explaining these things and thinks your mother understands. Bedside manner and checking in with a patient is a skill that physicians sorely lack sometimes and they just don't know that the patient has no clue and or they don't care.
The best way to combat this is to continually ask questions until you understand. Being blunt may help. I find its sometimes more useful to talk to a social worker/nurse someone else involved in care if you can't get the information out of the doctor.
posted by AlexiaSky at 1:50 AM on April 25, 2021 [3 favorites]
The best way to combat this is to continually ask questions until you understand. Being blunt may help. I find its sometimes more useful to talk to a social worker/nurse someone else involved in care if you can't get the information out of the doctor.
posted by AlexiaSky at 1:50 AM on April 25, 2021 [3 favorites]
Seconding that it's likely a failure on their part. If you don't get any traction with the department she's in, check if the hospital has an ombudsman/customer assistance department or something along those lines. They're often able to get results quickly.
posted by trig at 2:13 AM on April 25, 2021
posted by trig at 2:13 AM on April 25, 2021
They quite often don’t consider talking to the patient or family a priority, agreeing. The key is for the patient to be awake during rounds (when the surgeon checks in on patients) so she can ask questions. I’m assuming her spouse can’t be there given Covid. So your mom would need to be. There’s no way a nurse is calling a spouse exactly when the doctor is by. But that’s the opportunity, during rounds. Could be early morning or whenever. Discharge is usually done by a nurse. After that, nothing, maybe records if you can get them, or the opinion of the GP (who has obviously no inside knowledge of what happened).
The opacity of medical goings-on in hospitals shocked and pissed me off no end when I first dealt with it. Things do sometimes move quickly, they don’t always know what’s happening with the tests, and I guess they don’t have time to communicate what they do know. The only way I have ever been able to get info (pre Covid, as an adult child) has been to be by the bedside and to bug the nurse to tell me what’s going on. (Somewhat less successfully with day nurses, who are likely to be busy and maybe not inclined - the night nurses are more chill and available and imo humane that way. Bug and bribe with donuts. Can’t do that now. But you can call and see if you can get a summary, wouldn’t necessarily get details).
Edit: if your mom is in the CICU she’s probably better off sleeping if it’s early though, tbh.
posted by cotton dress sock at 2:55 AM on April 25, 2021 [2 favorites]
The opacity of medical goings-on in hospitals shocked and pissed me off no end when I first dealt with it. Things do sometimes move quickly, they don’t always know what’s happening with the tests, and I guess they don’t have time to communicate what they do know. The only way I have ever been able to get info (pre Covid, as an adult child) has been to be by the bedside and to bug the nurse to tell me what’s going on. (Somewhat less successfully with day nurses, who are likely to be busy and maybe not inclined - the night nurses are more chill and available and imo humane that way. Bug and bribe with donuts. Can’t do that now. But you can call and see if you can get a summary, wouldn’t necessarily get details).
Edit: if your mom is in the CICU she’s probably better off sleeping if it’s early though, tbh.
posted by cotton dress sock at 2:55 AM on April 25, 2021 [2 favorites]
From a doctor's perspective: ICU teams round early, like 6am. The rest of the day is spent putting out fires (we are still in a pandemic, remember). It's less likely intentional withholding as "this person's ok, moving on to use my cognitive load on someone else who is not." There's also a lot of shift work in an ICU setting, which can make it hard for a patient to know who "their" doctor is.
What's more, 99% of tests ordered in an ICU setting are to rule out a worst case scenario, and when they come back normal, the team sort of moves on, thinking no news is good news. And some of the results may not even be back yet, depending on what was sent. One test I routinely order in the outpatient setting is only run on Mondays. So if you draw the blood on Tuesday, you gotta wait a whole week! No test should ever be interpreted in isolation, so if there is something outstanding they may not be able to tell you anything meaningful until it's all back.
Best thing to do if she is still hospitalized is to ask for a meeting with one of the doctors, maybe in the mid afternoon, but the ICU nurses will have the best sense of the daily rhythm of the unit. If someone else can be there, great, but otherwise on speaker/zoom, is good. Get a summary/run-down of what was done and what they found and what, if anything, they are still looking for.
If she is being discharged soon, she should set up an appointment with her PCP or cardiologist and go over results (hopefully same hospital system).
Lastly, the 21st century cures act now mandates that all test results be available to patients via portal immediately when finalized. So if you are in the US she can get them that way. But as charmedimsure mentions, records are most helpful when someone helps you interpret them.
I wouldn't go down the ombuds/patient advocate avenue unless you have concerns about the quality of her care beyond failing to tell you test results.
posted by basalganglia at 3:20 AM on April 25, 2021 [9 favorites]
What's more, 99% of tests ordered in an ICU setting are to rule out a worst case scenario, and when they come back normal, the team sort of moves on, thinking no news is good news. And some of the results may not even be back yet, depending on what was sent. One test I routinely order in the outpatient setting is only run on Mondays. So if you draw the blood on Tuesday, you gotta wait a whole week! No test should ever be interpreted in isolation, so if there is something outstanding they may not be able to tell you anything meaningful until it's all back.
Best thing to do if she is still hospitalized is to ask for a meeting with one of the doctors, maybe in the mid afternoon, but the ICU nurses will have the best sense of the daily rhythm of the unit. If someone else can be there, great, but otherwise on speaker/zoom, is good. Get a summary/run-down of what was done and what they found and what, if anything, they are still looking for.
If she is being discharged soon, she should set up an appointment with her PCP or cardiologist and go over results (hopefully same hospital system).
Lastly, the 21st century cures act now mandates that all test results be available to patients via portal immediately when finalized. So if you are in the US she can get them that way. But as charmedimsure mentions, records are most helpful when someone helps you interpret them.
I wouldn't go down the ombuds/patient advocate avenue unless you have concerns about the quality of her care beyond failing to tell you test results.
posted by basalganglia at 3:20 AM on April 25, 2021 [9 favorites]
99% of tests ordered in an ICU setting are to rule out a worst case scenario, and when they come back normal, the team sort of moves on, thinking no news is good news.
Fwiw, having seen various family members through hospital stays - patients' psychological health also matters, and the cumulative stress of spending days without knowing what's going on, with no communication you don't have to fight for on top of the underlying health stress, can be huge. Communication is an integral part of care. I know it's common practice for hospital teams to ignore this, but that's not really something to defend.
posted by trig at 5:26 AM on April 25, 2021 [1 favorite]
Fwiw, having seen various family members through hospital stays - patients' psychological health also matters, and the cumulative stress of spending days without knowing what's going on, with no communication you don't have to fight for on top of the underlying health stress, can be huge. Communication is an integral part of care. I know it's common practice for hospital teams to ignore this, but that's not really something to defend.
posted by trig at 5:26 AM on April 25, 2021 [1 favorite]
trig, I agree. I'm not trying to defend either over-ordering tests nor the anxiety of poor communication. Just providing a little insight into why this might be happening, and give the OP some concrete ways they can get information from the ICU team.
posted by basalganglia at 5:37 AM on April 25, 2021 [7 favorites]
posted by basalganglia at 5:37 AM on April 25, 2021 [7 favorites]
I totally agree with basalganglia (I'm a doctor who works in a CICU, I'm not your mom's doctor, etc etc)--not defending the behavior, but that's the general explanation for why a patient might have a test and not know the results three days later.
I don't think you need to go so far as to set up a meeting if you just want to know the results. If I were you I would call the unit--ideally in the early afternoon when rounds are over but the day team is still fully staffed--and explain that you would like to review the results of your mom's X (cath, cardiac MRI, whatever it was) with the doctor. The might put you off and say they need to call you back if all the doctors are currently engaged in stabilizing a sick patient, which happens a lot in the ICU, but you should eventually be able to get a doctor on the phone, either by waiting for a call back or calling again after a reasonable period of time has passed (e.g. they say they will call you in 30 minutes, there's no call within an hour, you call again).
Again, I don't think it should be this way, this is just the dynamic I've observed in CICUs, especially during the pandemic.
posted by telegraph at 6:15 AM on April 25, 2021 [8 favorites]
I don't think you need to go so far as to set up a meeting if you just want to know the results. If I were you I would call the unit--ideally in the early afternoon when rounds are over but the day team is still fully staffed--and explain that you would like to review the results of your mom's X (cath, cardiac MRI, whatever it was) with the doctor. The might put you off and say they need to call you back if all the doctors are currently engaged in stabilizing a sick patient, which happens a lot in the ICU, but you should eventually be able to get a doctor on the phone, either by waiting for a call back or calling again after a reasonable period of time has passed (e.g. they say they will call you in 30 minutes, there's no call within an hour, you call again).
Again, I don't think it should be this way, this is just the dynamic I've observed in CICUs, especially during the pandemic.
posted by telegraph at 6:15 AM on April 25, 2021 [8 favorites]
Your mum needs to ask about it and keep on asking. No need to be rude, but be firm and polite and keep on asking. I'm not a doctor, but my mother spent a lot of time in the ICU and hospital in my life and sometimes you just have to be a stubborn terrier to get information from doctors and nurses in ICUs as everyone there is usually crazy busy and focused, Some tips, know exactly what you want to ask them, have it written down if needed. If you think you might have follow up questions afterwards ask the doctor the best way to contact them in case you do. Just keep politely but firmly asking and reminding.
posted by wwax at 9:38 AM on April 25, 2021
posted by wwax at 9:38 AM on April 25, 2021
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At this point I would not chalk this up to withholding without other evidence. Maybe they just forgot! Maybe what they think is important is not what you think is important, or most patients don’t want to know whatever the level of detail it is you feel you are currently missing! Whatever the issue is can likely be resolved by your mother or her authorized advocate calling and speaking to the cardio folks about whatever details seem missing.
This is big scary stuff to your mom and family, as it would be to any family. Sometimes doctors forget that because they put in a billionty stents a month or whatever, and don’t communicate as well as they should when things seem to, on their end, be resolved well enough and as expected. It is reasonable for your mom to ask for whatever information or explanations she needs, and any reasonable doctor would provide that for her (if they don’t, she is entitled to request a copy of her medical records! But medical records are more helpful when a knowledgeable person explains them.).
posted by charmedimsure at 1:48 AM on April 25, 2021 [3 favorites]