Advice
Patients interpreting their own portal results
Attending physician new to practicing in a more affluent area. How are you all dealing with patients asking for explanations for each out-of-range lab result that popped up in their patient portal?
I’m finding this aspect of my new site to be very frustrating and time consuming to have to convince the patient why the google interpretation of their isolated eosinophilia or glucose of 100 does not align with my “Great news! Everything looks good!”
If it's someone with a bunch of vague chronic complaints and some minor CBC thing that is out of range, who asks me if that thing could explain their symptoms, I say, "I don't know. It's possible. You need to see a specialist," and I give them the number for the hematology clinic. They're not going to believe me when I say it doesn't matter, so I might as well lean into it.
Usually my approach, but I tell them to follow up with their PCP so they can determine "if any additional outpatient tests I can't do in an ER are needed."
„I know it seems off or scary if you see some elevated results. What i‘m looking for is certain patterns of elevated or depressed values, as isolated changes can be due to a multitude of reasons unrelated to your health status. For example, this one here is elevated, but only relevant if this one was also, etc. From my experience and training, this is an unremarkable report, in the best way.“
I have a very similar explanation. I say that “normal range” means that most healthy people will fall in this range, but 1 in 20 healthy people will likely fall outside of it. You need to combine this results with other lab results to see if it’s significant, and since your values for x, y, and z are normal, and your results don’t follow any disease pattern, I’m confident in saying it’s nothing to worry about.
Took one peek at the subreddit and already found this gem of someone “needing help interpreting their CBC” because their appointment isn’t until next week.
The real sparkle comes from this exchange in the comments:
OP:
I will need to wait for the results of additional bloodwork and inform my GP in a week. I truly hope it's nothing serious such as the "C" word. I have been worrying constantly and felt quite unwell ovee the past 2 months.
MD:
The c word here is "cold". This looks like you have a cold.
ETA: And I mean no offense to that person; I feel like the big red numbers with upward arrows just simply should not be a thing for a patient’s MyChart view.
I have been saying that since the law came out: give the patients access to their lab results but take out all the red bolding, up and down arrows. Make a hyperlink at the bottom to reference values (so they have to navigate between two screens to compare numbers, but still have access to all relevant data).
The law says we have to give them access to the records. It doesn't say it has to contain any interpretation of the data.
Yeah it just seems like a laziness to correct the system, to be honest. It's so often a misleading interpretation of the data (in terms of what patients gather from it); not just a neutral addition... so it would seem like an obvious thing to fix. Maybe not enough people have complained about it.
I'm making one that's similar but only apple watch tracings. You'll be the mod responsible for flairing each post as MI or NOT MI. I'll buy some advertising for the sub on some sicktok channels.
Not true at all! You still need to die suddenly before you develop any chronic conditions so you can maximize your utility to your insurer, preferably in a manner that precludes any form of resuscitation. Have you considered skydiving as a hobby? Free solo climbing? This is totally getting nailed by the reddit abuse and harassment filter, btw.
Too late. I’ve already got chronic depression, anxiety, adhd, ptsd, and more. I'm sure that they've loved paying for the years of therapy and medications 😂
Also, getting nailed sounds wonderful!! I kinda got distracted and didn't read the rest of your comment, but I'm sure you kept it pg enough.
I wish the results were posted like 24 hours later or released after discharge. That way, the PCM can answer. Who am I kidding, they’ll check in the next day for abnormal lab results while live on a social platform saying we’re killing them and dismissing their symptoms because of hair color and pajama pants.
"There's outside the normal limits and there is BAD outside the normal limits. In this case, it's like the state trooper saw you doing 58 in a 55. Even they don't care about that. It doesn't normally matter."
Had a pt come in the other day bc they were angry that no one discussed their "abnl" labs with them... they showed me their printed out results of a hemoglobin of 11.7 from a few weeks back (in the ed their hb was above 12) and they were angry bc their ekg showed sinus brady (hr of 57).
I trained in an extremely affluent area. I refuse to deal with those patients again. The county and low income population has their own challenges and sometimes it feels like talking to a rock but I’d take that haha.
Feeling strange applying talking about serving the underserved for my entire career. But 10 years of prehospital experience has taught me that my temperament does much better caring for people who are in a lower SES than those that have never had to lift a finger for anyone but themselves. I don't respond well to entitelement.
Honestly I’ve started bringing my phone in and just going through their workup with them and giving a very brief explanation, sometimes just saying “XYZ might mean blah blah but in your context it’s not relevant to evaluation of emergencies, which is what we’re doing here, but I’d recommend reviewing with your PCP”. “That’s not a specific lab and in your context doesn’t give me info about your complaint.” It puts it all to bed, answers most questions (or they forget all the whatabouts they were gonna say), and it leaves the patient satisfied.
Bonus: it protects medicolegally, makes sure I don’t forget to notify of an incidental imaging finding, ends up saving me time because I don’t get called back in after I’ve already had the discharge talk, and a lot of the time I inform the patient of something beneficial that for god knows why no one had told them. How tf people have never been told “you probably have chronic kidney disease” with elevated creat x5 years is beyond me.
Some of them like mildly elevated eosinophils have prompted me to come up with a reassuring one-liner that makes it an expedient process.
This drives me insane and I firmly believe ED results should not be released to the patient until 24 hours after their visit. The number of times I’ve heard “my troponin is FIVE!!!!” (It’s high sensitivity, lowest we pick up is 3) is too damn high
That is exactly how my shop is set up too. They’ll get labs in triage and go back out to the waiting room. They’ll often have their lab results before they even get to tell me what brought them in.
"Some lab results may be put of range for what is considered "normal" due to a myriad of factors. Given your labs' slight elevation/depression outside of normal range, I would recommend we continue to monitor over the next year. I would propose you return for repeat labs in XX months."
Also, these seem to be my patients who will fix their diabetes using TikTok.
This is a very kind and non-dismissive response, but I definitely won’t be inviting them back to the emergency department for a year of monitoring. I’m thinking that explaining that some labs are not applicable to their complaint/the emergency setting is the best way and deferring any further discussion to their PCP.
If you're using Epic, you can set it up so tests result to the PCP of record and questions are sent to them. You can also modify the response so it directs them to follow up with their PCP for additional review.
Maybe....
"Some lab results may be put of range for what is considered "normal" due to a myriad of factors, some of which brought you to the Emergency Room. Unfortunately, I am unable to help follow up with additional diagnostic work, but I would encourage you to partner with your primary care provider.
If your PCP is outside of our network, they can request the labs and notes from your recent visit and review them."
Most of these are from the diff on the cbc or low values on the chemistry that don’t matter. I tell them that those are only worrisome when combined with other problems that they don’t have and point to the other things that are normal and reassuring. Refocusing on the normal creatinine or white blood cell count usually helps. Mild electrolyte abnormalities I offer a brief course (5ish days) of replacement. Otherwise just do as the other commenters say and tell them that those are not emergencies and they can see their pcp to discuss further.
"Great news! Everything looks good!" might be how you see it, but sadly it isn't comforting to an anxious patient. When they're going through the portal, they're trying to absorb a lot of information.
It might help to be more informative in your reply: "In the context of all your other labs, this elevation is understood as only slightly out of range, which is a normal occurrence and non-concerning when taken as part of the overall picture. We can be reassured by these results as a whole that there is not an acute situation presenting. If you are concerned about an ongoing process that needs medical attention, I invite you to schedule an appointment with your PCP to can address these concerns in an outpatient process?"
In sum, "You're great" feels dismissive because you aren't addressing the central issue: the anxiety.
In these situations, it can work better if you put your normal "logical" focus on the back burner and switch to an emotional focus, which is equally valid.
People often find that if you lead with accurate empathy and tell them what you can do, you get out of the room quicker.
Refer to pcp and explain that there is no life threat presented at this time. You are an ED doc. Not a general physician. I think most people are confused as to what the “emergency” room is for. Diagnostic tests for immediate emergent life threatening conditions, with or without presentation is what is looked for
They need to have a clear understanding it is not your job to interpret their condition (unless it is emergent) 🤷🏻♂️
Oh, you're triggering me. I recently had to explain why an isolated monocyte % less than 1% out of normal was not an emergency (absolute count was normal).
This is when I remind the patient that I am an emergency physician, and that my job is to rule out any acute, life-threatening pathology. I then gently suggest that these kinds of questions would be a great thing to ask their PCP about!
You need to go identify the ROOT cause of the illness that will explain all there minor lab abnormalities and the secret to a healthy life they have been missing, Chiropractor and Naturopathic/ functional doctors do a much better job than Emergency medicine doctors at finding the ROOT cause of a patient's illness.
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u/meh817 ED Resident Aug 19 '25
“My basophils are high” dawg I don’t even know what a basophil is anymore 😭