Q&A with Dr. Robert Corona, DO
A new federal law proposes that individuals be able to access their lab results before their physician has the information. Right now, at least seven states allow direct access to patients. If passed, the law would force changes to processes and policies, says Robert Corona, DO, who chairs Upstate’s Department of Pathology.
What’s the impetus for this?
“There is interest in having patients have more accountability for their care.
“Sometimes when a physician gets 20 or 30 laboratory values a day in their office, it is easy for things to slip through the cracks. There have been biopsies results and abnormal lab values that never make it to the doctors for review. People have had their care delayed because they didn’t get the results. There is a lot of information to manage, and if patients are empowered to help themselves, the thought is this will improve care and outcomes.”
Is it a good idea?
“It’s troublesome to think that all laboratory data would be released and that patients are going to be left to interpret those data for themselves. I think we need to look at each individual lab test and what it might mean and how a patient might react.
“Lab results are just one component of diagnosing a disease. Without perspective, lab values can end up being misleading.
“For instance, let’s say there is a complex test that for the most part points to a benign diagnosis. The pathologist would share insight with the primary care doctor so he/she keeps a close watch on the patient over time. There may be no need to create anxiety for the patient, as the interpretation is complex and best left to the primary care doctor who is objective and has perspective.
“There’s a lot to be said for a primary care physician knowing the whole patient. We in the lab are just getting a little snippet of data.”
What would be included?
“Anything that involves tissue or body fluids.”
What role will laboratories play?
“The laboratories are going to have to work together with the clinical physicians. When the data’s released to the patient, if this law goes into play, the labs need to contact the physicians and let them know, ‘your patient has now been informed that they had a breast biopsy that has a borderline cancer diagnosis, and here are the options for communication.’ The laboratory will have to help educate the patients, as well.
“I think a pathologist may give an interesting perspective to the patient. Say somebody has a breast biopsy. We can sit down with them and say, ‘You need to go over what the therapy’s going to be with your physician, but here is a picture of your biopsy, and you can see that all of the cancer has been removed. You can see the margin of where the surgeon cut, and there’s no cancer at the margin.’ I think that will be very powerful, that image that the cancer’s out of the body.
“Pathologists already work closely with clinical physicians to help them understand the meaning of some of the tests. And there are so many new tests in the world of molecular genetics, cancer diagnostics, infectious diseases. It can get very, very confusing.”
Listen to this interview.
Find this and many other informative articles in the summer issue of Upstate Health, the magazine produced for Central New Yorkers by Upstate Medical University. Click on the magazine, at right, for a digital look at the entire issue.