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Delivering Health
Team Obama Vows: No More Dr. Middleman

The Obama administration has made a new federal rule that will allow patients in every state to get lab results back directly from the lab without going through their doctor. This rule will override all state legislation on the subject, even in those states that explicitly forbid direct lab-to-patient transfers. WaPo: 

Consumer groups said the rule will empower patients and reduce mistakes. A 2009 study in the Archives of Internal Medicine found that providers failed to notify patients of abnormal test results 7 percent of the time. Other estimates have put that rate higher.

“Providers are busy and overloaded, and this was an additional burden on them,” said Alice Leiter, policy counsel at the Health Privacy Project at the Center for Democracy and Technology, which advocates for a more open exchange of information, particularly online.

These kinds of changes may seem like small potatoes, but direct patient-lab contact is part of a class of policies that have the potential to streamline health care, empower the consumer, and free doctors up for the kind of work they are typically most passionate about. A whole raft of fixes like this could in aggregate do more to make our system sustainable over the long term than the most fine-tuned tinkering with subsidy levels.

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  • Mark Mazer

    In the US, 46% of the population believes in creationism ( I’m sure that they will be able to make heads or tails of their lab reports.

    • gabrielsyme

      Bullshit. You’re only demonstrating your own prejudice.

      • Corlyss

        While I take your point about the creationism crack (one that usually lights me up like a roman candle), and while I agree that the two are not related, I think his conclusion is spot on. This is going to be a mess of monumental proportions.

        • gabrielsyme

          I have no particular opinion on the policy. I have a major problem with Mazer’s argument, which is no more than rank bigotry.

  • Robert Bennett

    As a retired MD I can say that while your concept makes some sense, the practical effect will probably increase the burden on physicians. Many lab reports indicate normal and abnormal ranges. Many individual results will be flagged as abnormal when the significance of the minimal abnormality is nil, both in individual patients and in general. The handling of questions and fears of patients will require more time by the physician.

    • mgoodfel

      For people with chronic conditions, this will be great. I’ve sat waiting a week for my doctor to get around to talking to me about test results. I’ve seen the results before and am fully capable of evaluating them.

      Patients who aren’t comfortable with reading results will just ignore them and wait to talk to a doctor.

    • TommyTwo

      You seem to be implying that the current standard operating practice is for physicians to glance at the results covertly and then tell the patients that they’re fine, no need to worry their pretty little heads.

  • Corlyss

    So let me get this straight: in the name of empowering scientifically illiterate and easily spooked patients, most of whom are given to a fondness for susperstition, placebos, and snake oil, and other so-called remedies that “make sense to them,” regardless of validity, the Government will mandate that lab results bypass the only individual the patient knows who can interpret them? Have I got that right?
    Well, between drug companies direct advertising to patients and now patients interpreting their own lab results, this is going to be a fine mess guaranteed to bring down the quality of American medicine to the level of, say, the African bushmen’s.

  • Mark Mazer

    Well then. Let’s make the exact same point another way.

    “Barely more than a third of the public believes that genetically modified foods are safe to eat. Instead 52 percent believe such foods are unsafe, and an additional 13 percent are unsure about them.”
    (Poll, conducted for…

    I’m sure that they will be able to make heads or tails of their lab reports.

  • TommyTwo

    I agree with this policy, and I’ll also grant that there are a fair amount of irritating idiocies in the myriad laboratories of democracy. But that The Leader should issue an edict, and poof! all explicit state
    legislation on the matter goes up in smoke?

  • Boritz

    If my T level isn’t as high as Arnold’s I’m going to the border for an Rx.

  • qet

    Did the study specifically project increased costs associated with the mistakes? Or are you just inferring that the 9% mistake rate simply must have increased total system costs, somehow? You don’t always need a cost argument to support reducing mistakes in the delivery of medical care. And Via Meadia had better not let itself get too carried away with its own dogma on this topic. Encouraging people to see doctors primarily as cost generators and then demonizing them with self-indulgent rhetoric like “we need to crush them beneath our feet” is not what I would consider sound thinking. And I really wish Via Meadia would stop with the sophomoric utopian garbage about how changes to economic policy will finally free humans from the drudgery of having to earn a living so that they can indulge their passions like gardening and watercolors. The practice of medicine is not reducible to the laying on of hands and the uttering of imprecations. Even Hippocrates had to earn a living as he was busy becoming the patron saint of medicine. Medicine is a for-profit business. Sheesh!

  • lhfry

    So is it possible to go to a lab and get the blood drawn and the tests done without a doctor in the middle? I would like that. With all of the resources available one could read and learn to interpret results without intervention from an MD. In my experience, MDs don’t always know very much either. Often, if you do the research yourself you will know more than your GP about your own situation.

  • Robert Bennett

    reply to Tommy Two.
    I also believe that patients have a right to their lab results, but these results require interpretation. A moderate rise in blood glucose is normal in a non-fasting specimen. Low potassium and high blood urea nitrogen levels are “normal” in the initial evaluation of a patient with acute dehydration due to diarrheal disease. These and multiple other examples require explanation to the patient if they are brought up. The point of my initial comment was to point out that this rule will increase patient’s concerns and the number of questions to physicians, thereby causing an increase in the time burden on doctors, not a decrease as suggested in the original article. In addition there will be at least a small increase in the cost of medical care from the requirement to distribute the massive amount of data involved.

    • TommyTwo

      I don’t disagree that results might not ne intuitively obvious to the layman, but my objection to your initial comment lies in the sentence: “These and multiple other examples require explanation to the patient if they are brought up.” For the new policy to increase demands on physicians means that they were previously deliberately not bringing up specific results. “[Glance at some sheets held away from the patient.] According to the results, you’re OK. Next.”

  • Alexander Scipio

    Hmmm.. and federal legislation (or is it an EO?) supersedes state laws when no enumerated power assigns this power to the feds… because…?????

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