New York Severs Pathologist-Patient Connection

The New York City Health and Hospitals Corporation, which operates the public hospitals and clinics within the city, have joined New York pathologists and CAP (the College of American Pathologists) in a call to repeal a bill previously passed by the New York State Senate (1). The bill in question allows patients to receive results direct from the lab upon request, but prevents the pathologist who performed the test (and understands the results) from interacting with the recipients and explaining the meaning of said test. Critics of the bill claim that this could leave already anxious patients in a worse state when presented with a sheet of paper with figures and alarming science which they may not understand. “Given the advances in diagnostics and explosion in diagnostic data, pathologists interacting with patients directly as part of the healthcare team can only enhance patient outcomes and patient satisfaction,” says Michael Prystowsky, professor and university chairman of pathology at Montefiore Medical Center and Albert Einstein College of Medicine, New York.

The bill, which ironically also blocked any laws preventing patients directly receiving test results from the lab, was finalized in February 2014 despite protests from CAP, which felt that results were best explained thoroughly by a physician when first presented to the patient in order to eliminate confusion and to address patients’ concerns (2). The state declined the repeal, however, and responded by stating, “A clinical laboratory that provides a patient with the meaning or interpretation of the test results is discharging the ordering physician’s responsibilities and such discharge is of decided benefit to the physician, precluding the practitioner from incurring expenses or expending time,” (3).

This comes at a time when pathologists are being increasingly encouraged to become more and more involved in patient care. And rightly so; the benefits for the patient, clinician and pathologist are obvious, but this interaction is especially important in those cases where clinicians are not actually confident in interpreting the results of a test. Worryingly, research has found this to be true in some cases; for example, in a survey of UK junior doctors, over 40 percent admitted that they were not confident in interpreting results for laboratory tests such as urine sodium and osmolality tests (4). Furthermore, when Gerd Gigerenzer of the Max Planck Institute for Human Development in Berlin, asked 160 gynecologists how many women testing positive on mammogram screening actually have breast cancer, disconcertingly, the majority answered 81 or 90 percent. Only 21 percent correctly answered one in 10 (5). These are just two of many studies that add credit to the pathologist-patient link and fuel the argument against the bill.

New York pathologists have been quick to show their disagreement to the new rules; physicians located throughout New York have affixed their signatures to a CAP response providing additional arguments and references for the repeal (6). “As physicians, pathologists have a legal and ethical obligation to care for their patients,” says Prystowsky. The pathology community is not going to take this lying down. But will New York listen?