Evaluating the Doctor’s Office: Who Do You Talk To About Laboratory Results?

Earlier this week I was meeting a new rheumatologist to possibly replace my doctor who has retired. Ahead of time I picked a few questions to help determine if we might be a good fit. But I was also quietly evaluating the office and its staff - from the logistics of parking, to the receptionist and nurses, and the efficiency of the visit overall.

After negotiating the confusing parking lot and navigating my way through the building to the office, it didn’t take long to get checked in. I was a few minutes early so I read email on my phone and worked a monster Sudoku puzzle. After about 20 minutes, I made eye contact with another patient and we started a brief conversation.

I asked her: How long does it normally take before you’re called back for your appointment? She gave me a sheepish look, so I encouraged her - no, honestly, how long does it take? She said that sometimes it’s “not too long” but that it was an hour for a recent appointment. She asked if I had been waiting long, which I had not, but I noticed that no one had been called back during the 20 minutes I had been waiting and the number of people in the waiting area was growing. (I ended up waiting 30 minutes.)

Not long after this discussion a woman came in and approached the registration desk. She wanted a copy of her lab results and to talk to “whomever it is that usually calls with test results.” The girl at the desk said that person could be any one of them, depending. The previous Friday, the woman had received a phone message regarding lab work and was confused about instructions given to change her medication. She had been trying to call the office all morning and couldn’t get through so she drove up to the office instead.

Based on the conversation, it became apparent that the woman wanted to understand a few basic things: what was abnormal about her lab results, what was the significance of specific tests, why was she being asked to change her meds, what was that supposed to do, and how would she know if the change successfully accomplished what the doctor wanted?

She was obviously concerned and somewhat confused. But rather than offer to let her talk to the nurse, the receptionist responded to her questions with superficial answers that didn’t explain much of anything. I wanted so much to be able to interpret for her what was being said. Her liver enzymes were elevated which is why her doctor wanted her to only take 2 methotrexate tablets that week instead of her usual dose. The patient also wanted to know about SED rate and a few other tests. Her questions had answers, but probably not ones which should have come from a receptionist.

At some point on our patient journey, we didn’t know everything we currently know. We were uneducated but were able to pick up information along the way. There was a time I didn’t know what SED rate measured or that liver enzyme tests were important for determining my ability to stay on methotrexate. I had to learn what these things meant and how they might affect my care.

But I learned these things from my own doctor. Not a nurse, definitely not a receptionist, and not from another patient. As a patient advocate, I have shared my gained knowledge about many things, but I always try to make sure that what I share can be backed up by medical literature or information published by reputable sources.

When it comes to my own blood work, I’ve usually already downloaded the results before someone from my doctor’s office (most often the nurse) calls. Often I’m simply told that everything looks “fine.” But if I ask for a specific result, I will be given the number. The person on the other end of the phone has the knowledge, training, and experience to discuss the results with me. However, if the results of the test affect changes in my care, my doctor will call me personally so she can explain and I can ask questions.

I’m fortunate to have had wonderful doctors, past and current. But as I was evaluating the potential new-to-me doctor on Monday, her office scored negative points before I even met her. Fortunately, I really liked the doctor and have hopes that we can establish a good relationship. She even earned extra bonus points in my eyes - she has other patients who live with MS and RA. Cool! We’ll see how this works out, but I think I’ve just found my next rheumatologist.