Patient Portals—Too Much of a Good Thing? Removing the Humanity in Medicine

This week on The Doctor Is In, we will be discussing patient portals—a relatively new addition to hospital and laboratory care in Ontario.  In the last several years, most hospitals have adopted digital portals that allow patients to look up their health information, including test results, consult notes, and more.  They were designed to ensure that patients have easy access to their health information, which is their right as a patient in Ontario.  Empowering patients to be involved in their care is incredibly important.

But there is a challenging problem that has arisen from the implementation of these tools—patients are often receiving their results before their physicians are able to see them.  This isn’t because doctors are neglecting to look at their results or are simply not working fast enough.  This is because physicians are seeing patients all day and are looking at their results before clinic, in between patients, and after hours.  Imagine if your doctor immediately started looking at another patient’s results while you are in an appointment with them…this would ruin the therapeutic relationship.

But while physicians are obligated to find time between their patients to review results, patients are notified immediately by email when there are new results available for them.  And then they are able to log in and review these results.  The challenge with this is that they are not able to review them with the context that their doctor brings to the results.  Sometimes there is a result that is out of normal range, but is not clinically significant.  For example, many women will have white blood cells present in a urinalysis because it can be normal to have them present in the bladder for women. Yet this shows up as an abnormal result which is understandably scary to receive as a patient.

This can create tension between a physician and patient because the patient is concerned why their doctor isn’t getting back to them immediately with an abnormal result while the doctor will look at the results later that day, triage it as normal, and wait until they have the time to inform the patient of a normal result.  While the patient is waiting for the doctor to contact them, they can become understandably irritated that their abnormal results seem to be being ignored by their doctor.

And the opposite problem can occur as well—sometimes the diagnosis being disclosed on a test result is significant, life altering, or life ending.  And receiving that type of news from a computer screen instead of from your doctor is not what patients deserve.  They deserve to have information like this disclosed in a compassionate and skillful manner, where patients have the opportunity to ask questions.  My father passed away last year from terminal pancreatic cancer.  He discovered his diagnosis on his own reading a CT report.  He told me it didn’t upset him to learn about the diagnosis this way, but that is because of who he was, his personality gave him the tools to cope with that news on his own before his incredible doctor called a few hours later.  Not everyone would respond that way, and not all patients will trust their doctors after having life changing information disclosed to them in this manner.

So the question is, how do we manage these pitfalls?  Patients deserve access to their records, no question. But they also deserve learning about the context of their results from a licensed physician who knows them.  My preference would be a 24-48 hour delay on the release of results to give physicians an opportunity to review the information and reach out to the patient.  If there is a critical result where the patient’s life is in danger without being immediately contacted about the results, this delay can be overridden.  This ensures in a critical situation that a patient can receive information that could potentially save their life if they receive it sooner.  But most results can wait 24-48 hours.  We are allowing digital health tools to remove the humanity of medicine.  Patients deserve a therapeutic alliance with their doctor, they deserve to be spoken to with compassion.  And they deserve to have a trained professional with the clinical context who can explain what their results mean.