Date Published: March 24, 2017
Author(s): Naadira Vanker, Norman H. B. Faull.
Challenges and uncertainties with test result interpretation can lead to diagnostic errors. Primary care doctors are at a higher risk than specialists of making these errors, due to the range in complexity and severity of conditions that they encounter.
This study aimed to investigate the challenges that primary care doctors face with test result interpretation, and to identify potential countermeasures to address these.
A survey was sent out to 7800 primary care doctors in South Africa. Questionnaire themes included doctors’ uncertainty with interpreting test results, mechanisms used to overcome this uncertainty, challenges with appropriate result interpretation, and perceived solutions for interpreting results.
Of the 552 responses received, the prevalence of challenges with result interpretation was estimated in an average of 17% of diagnostic encounters. The most commonly-reported challenges were not receiving test results in a timely manner (51% of respondents) and previous results not being easily available (37%). When faced with diagnostic uncertainty, 84% of respondents would either follow-up and reassess the patient or discuss the case with a specialist, and 67% would contact a laboratory professional. The most useful test utilisation enablers were found to be: interpretive comments (78% of respondents), published guidelines (74%), and a dedicated laboratory phone line (72%).
Primary care doctors acknowledge uncertainty with test result interpretation. Potential countermeasures include the addition of patient-specific interpretive comments, the availability of guidelines or algorithms, and a dedicated laboratory phone line. The benefit of enhanced test result interpretation would reduce diagnostic error rates.
Laboratory services play an integral role in the healthcare system – from primary- through to tertiary-level care – since diagnostic tests can either confirm or exclude a tentative diagnosis, or screen for potential diseases.1 The underlying purpose of laboratory testing lies in the association between laboratory test results and the potential to improve a patient’s health status. This requires ordering a test when appropriate and necessary, accurate interpretation, and acting upon the result.2
This study found that primary care doctors in South Africa experience challenges with laboratory test result interpretation in approximately 17% of their diagnostic encounters. By comparison, a similar study conducted in the United States found that primary care physicians reported uncertainty in 8.3% of diagnostic encounters. This emphasises the need for improved mechanisms and countermeasures to aid South African doctors with result interpretation.