People admitted to a hospital are not expected to be — and usually are not — experts in hospital policies and practices. This is no surprise. Why would they be ? No one studies up for a hospital admission.
Therefore, a reasonable but often mistaken assumption of patients when admitted to a hospital is that they will receive the results of all tests ordered for them in the hospital. This is not a correct assumption. We discuss why below, and explain the importance of knowing about “incidental findings” showing up during your hospital stay.
Hospital staff are not primary care physicians. They are usually part of a service (group or department of doctors) such as trauma, neurosurgery, cardiac, critical care, or orthopedics. They will treat you for your admitting condition that brought you to their service. They may order a consult for a related condition, but they are not comprehensively reviewing your health condition. If it does not relate to the admitting condition for which they are treating you, do not assume that they will engage or treat that condition. This makes sense. They are only treating you for the condition or injury that caused your hospitalization.
This also may hold true when a service (i.e. orthopedics, or trauma) orders tests for the condition for which they are treating you in the hospital. Those tests may come back negative for questions about the admitting condition but show what is called an “incidental finding.” This is something that shows up on a test result that is not related to the reason the service or doctor ordered the test result. These incidental findings can be critically important to you, but unrelated to the reason you are in the hospital. The classic example is a cancerous lung nodule that shows up an x-ray for rib fractures. While not relevant to the rib fractures, the cancerous lung nodule might be fatal down the road.
Radiologists have well developed practices and procedures for advising the attending physician about such an incidental finding in this example. However, other medical specialty group practices may not have established procedures. For example, a trauma service group that receives an echocardiogram that shows an aortic aneurysm but is clear for trauma related findings, may not tell the patient or her primary care provider about the aortic aneurysm. The rationale often stated is that the aortic aneurysm is small and not an immediate problem, and that it is not a trauma issue that would be handled during the admission at issue. In one such case, the patient died four months after the hospital stay from such aortic aneurysm. No one could explain why the patient, his wife, or the primary care physician were not informed of the aortic aneurysm.
New York state has rules and regulations that speak to what must be disclosed to the patient and her primary care provider. See 10 NYCRR 405.7 and 405.9.
There are three things that you can do to determine whether a potentially dangerous incidental finding has surfaced during your hospital stay:
- Once a test result comes back, a good question to ask the medical provider in the hospital ordering the test — “Is there anything in these test results that is not important to your care but that I should discuss with my primary care physician after discharge?” This is also a good question to ask the medical provider discharging you from the hospital.
- After discharge, call your primary care physician and ask if she has received the hospital discharge summary and any test results from the hospital and whether an appointment is necessary to follow up. Then ask her the same question.
- After discharge, order your hospital admission records from the hospital. You can usually get them on disc from the hospital medical records department for $6.50. Review them with the understanding that much of the record will be daily charting of your hospital stay. Also please remember that you are not a doctor and that what might seem concerning to you might not raise an eyebrow for an experienced clinician. However, if there are test results or findings that appear concerning to you, discuss them with your primary care physician. More than likely, they will turn out to be nothing. Statistically, most incidental findings are benign and do not require follow up. However, not always. Sometimes test results or findings from a hospitalization need attention after discharge for your future life and safety.
So yes, it takes a bit of extra work, and follow-up. But better safe than sorry to ensure that there is no incidental finding that is better dealt with now than later.