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I've got a new pet peeve: patients who ask to be notified of their test results. The universal system is this: if something is found, the patient gets a call. If nothing is found, the policy is “No news is good news.” If they haven't heard from us within a certain time frame, they shouldn't worry, everything is fine.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/174/9/1376/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/174/9/1376/F1)

Figure. Photo by: Fred Sebastian

Recently, several patients complained they weren't told their test results. During later follow-up appointments they said they'd worried every day that something was wrong, and that we could have alleviated their anxiety with a simple phone call. “If I don't hear, what am I supposed to think? The worst, or that you might have lost the results and that's why you didn't call?”

I tell them the provincial health insurance doesn't pay us to call patients when their test results are negative. I explain that I'd have to hire another staff person, whose job was dedicated to phoning patients all day with negative test results. It would be expensive. Most are satisfied at this point. But some get dirtier: “Is that what it comes down to, how much money you can squeeze out of the system?”

I'm tempted to say something sarcastic, like, “Yes, money. When I look at you I see a big fat juicy dollar sign that'll fund my Cancun villa and third wife, all because of your misery, and thank you for your patronage, next please.” Or something sweeter: “If you don't like it, get another doctor.” But I usually put the responsibility back on their shoulders, which, in my opinion, is where it belongs: “You can always see me after your tests are done to discuss the results, whether they show anything or not. That way you'll always know.”

There is one exception: the patient whose test results do *not* make it back to my office. On the rare occasion when an important result is lost, be the fault my own, or the lab's or imaging department's, I of course change my tune somewhat hypocritically. I ordered the test, I'm responsible for the result. I don't take the patient to task for failing to book an appointment to discuss results. I instead feel responsible for the error, and I apologize. On one occasion, when a chest x-ray showing a solitary nodule got misplaced or forgotten, I considered hiring that extra person to chase down patients about their lab results. But I admit it: the cost would have been too much. Is this unethical?

I've debated offering every patient the chance to return to discuss their test results, but I'm simply too busy. I need to see sick people, not people who are well. It would do my practice a disservice to spend an inordinate amount of time where it can be better spent. One missed chest x-ray might be better than not finding a dozen cancers and a host of anemias, or not having time to treat plagues of headaches and irritable bowels.

So: no news continues to be good news, except for the rare patient who hears no news when the news is bad. Then it's bad news for me, and for them.

— *Dr. Ursus*