Consumer/Quality Insider: Preparing for a Medical Test

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Rand: This is Healthcare 411 for the week of December 6, 2006. Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. I’m Rand Gardner. Every day across the country, millions of people see a clinician for a medical problem or just for a checkup. The clinicians ask the patients questions about their health and do a physical exam. If that’s not enough to know everything they need to know about a patient’s health , t hey may order medical tests for their patients such as a blood chemistry, x-ray, ultrasound or another test. The results of these may help diagnose a medical problem or determine that a course of treatment is working. Other tests’ results will help a doctor and patient make decisions about the best treatment for the patient. But what should the patient know about these tests? Plenty, according to Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality. Debra James recently sat down with Dr. Clancy to find out more about being prepared for a medical test.

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Debra: Dr. Clancy, if I go to my doctor and she tells me I need a medical test, what should I know about it?

Dr. Clancy: It’s a really good idea to ask your doctor about the test while you’re in the office or examination room. You should know what’s the name of the test, what exactly is going to be done, what kind of information the test will provide, and how that’s going to affect any subsequent decisions. It’s also not a bad idea to ask if there are any other options for getting the same kind of information in the case of diagnostic tests. After you get that information, you need to know how the test is going to be done. Is this going to be a straightforward blood test? Is it just going to be something where your finger is pricked? Is it some kind of breathing test? What exactly will be happening to you?

Debra: What do you mean? Can you elaborate on that?

Dr. Clancy: Sometimes tests are actually done in physicians’ offices. Other times, and more often, it requires going to a separate facility. It’s important to know what’s going to happen during the test. Do you need to do any preparation ahead of time, or will there be some potential side effects which might mean that you couldn’t go back to work right away? Better to know that ahead of time than to find out on the spot when they’re expecting you for a meeting that, in fact, you’re not going to be coming back until the next day. It’s important to ask ahead of time is this going to be uncomfortable or cause you any discomfort that you can prepare for. Some tests, for example, simply involve a relatively simple use of a needle to withdraw some blood. Others are much more complicated and require some preparation for a couple of days ahead of time. It’s important to follow all the steps that are given to you by a doctor or the facility, but how you prepare for the test has a lot to do with the quality of the results that are obtained.

Debra: Days of preparation? It really might take that long to prepare for a medical test?

Dr. Clancy: It depends on the test. For example, if you’re having a colonoscopy, which is a very important test to detect very early colon cancer in people over the age of fifty, that does require a couple of days. It doesn’t require every minute of those couple of days, but it’s something that starts a couple of days before the test is actually done. So it’s important that you know that up front so that you can arrange your schedule and so forth. Other tests will involve consuming a certain amount of liquid or it may involve not eating for a certain amount of time before the test is done.

Debra: How accurate are medical tests?

Dr. Clancy: It’s important to discuss with your clinician ahead of time why the test is being done and how accurate it’s likely that the results will be. For example, sometimes a test is done for the purpose of answering a "yes or no" question do you have a specific condition and the test results will be very reliable. You can be reassured if the answer is "no" and know what’s going to happen next if the result is positive. Other times tests are the first in a series of steps to try to find out precisely what’s going on. So it’s important to know that ahead of time whether you’ll have a particular diagnosis or whether more steps are likely to follow.

Debra: What about false positives and false negatives? How can you be sure you didn’t get one of those?

Dr. Clancy: A false positive result is one that comes back saying that you have a particular condition or abnormality that’s been found and it’s actually wrong. A false negative, on the other hand, has the potential to reassure you that everything is perfectly okay when, in fact, the test missed the abnormal finding. If you and your doctor think the test results may not be right that they don’t fit with everything else that’s going on with you then the usual practice is to repeat the test to make sure that the problem is the test and not with you, yourself. This is something that happens quite commonly. Commonly test results are defined in such a way that 95% of people will be in the normal range. That means if you have enough tests done, sooner or later you’re going to have a false positive. No test is perfect and it’s very important to ask questions if you’re told that, either your test was okay, and you still think you might have a problem or if you got a result back which doesn’t fit with everything else that’s going on with you. That’s a good conversation to have with your clinician.

Debra: Is there something that I can do to improve the accuracy of a medical test?

Dr. Clancy: To help make sure you get the most accurate test results, it’s important to follow all the directions as they’re given to you, and it may be important for you to know which lab that you’re going to be going to ahead of time, and if they have any specific requirements or recommendations for steps that you need to take before you come in for the test. Another step that you can do is when you go in to get tests, there will be labels with your name for specimen tubes, for papers that are being sent to the laboratory or to the x-ray facility, and so forth. It’s very important to make sure that your specimens actually have your name on the particular tube or pieces of paper and so forth.

Debra: What happens after the test? How long does it take to get results and how am I going to get them?

Dr. Clancy: Before you have any tests, you should ask your clinician what is their policy, or how do they let you know about the results? Some clinicians have a policy that no news is good news, so it’s important to know that. Others will routinely notify you of the results whether they’re normal or not. It’s important to know that up front and it’s important for you to let the clinician and the people with whom she practices know how they can reach you. For example, if you have voice mail are you the only person that listens to the messages. Can they leave a message about results or would you prefer to be contacted by email or through the regular mail. It’s very important that you know the results of any test that you have done even if you see a clinician who is of the "no news is good news" school of thought. By making sure that you know the results, you will also be reassured that the results didn’t get lost and that no news really meant that no results or information was passed on rather than the right results were obtained. In addition to that, you need to know from your clinician how to follow up on the results. Is there a good time of the day to call? Who is it in the office that actually routinely goes through lab results so that you can connect with that person and get the results as quickly as possible?

Debra: One last question If I want to get a copy of my test results, can I do that?

Dr. Clancy: You can absolutely get a copy of your test results to keep and many clinicians do this routinely. Others will be delighted to do so if you ask.

Debra: Dr. Clancy, thank you for your time today.

Dr. Clancy: Thank you, it was a pleasure

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Rand: That’s it for this week. For more information on these and other health-related stories and topics go to www.ahrq.gov. Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Debra James, I’m Rand Gardner. Please join us for the next edition of Healthcare 411.