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fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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The Portal

“Hello?” I answered the yellow phone with its coiled cord dangling from the kitchen wall. To my surprise, my doctor was calling ME, a seventh grader, with results of my blood tests. (Mono.) I still recall my shock that a doctor – practically a celebrity! – would call my home. Shouldn’t his staff be calling?

Years later, as first-year resident, I overheard my co-resident calling clinic patients with their results. I can still feel the flush that arose with the dawning realization that I was the doctor now; I was supposed to call my patients about their results.

Today, in our digital age, we have The Patient Portal. The portal allows patients to review test results downloaded automatically. Surely the portal creators did not envision its downstream effects – patients panicking about blood tests flagged as abnormal – even if barely outside the normal range. Gone are the days of reassuring patients by phone. Instead, we health care providers toil on evenings and weekends to keep up with the volume of patient messages and lab results needing follow-up.

When high-stakes results are downloaded to the portal before the provider can see them, the effects can be devastating. Recently a friend and physician logged into their portal to review their CT scan results on a Saturday night. The impersonal laptop screen informed them of the metastatic cancer that was causing abdominal pain. I can only imagine the shock and isolation of learning this news in such a manner.

Years ago, I was in the middle of a patient visit, and the nurse interrupted, knocking anxiously on my exam room door. What triggered this urgency? One of my patients had discovered via the portal that his biopsy showed a malignant tumor, before I had the chance to learn of these results. Fortunately, I was able to add him onto my schedule at the end of the day so I could help give context, reassurance and a plan. My dear patient and his partner spent unnecessary hours petrified and paralyzed, worst-case scenarios running through his head.

Despite the woes of the portal, sometimes I lament its absence. To obtain test results or consultations ordered at facilities which do not use my clinic’s electronic medical record, I must jump countless hurdles to track them down, resulting in delayed follow-up and stress for the patient and me. Often as I plug away at inter-visit clinic work at odd hours, I daydream about a national health care system with a universal electronic health record.

Pamela Adelstein
Newton, Massachusetts


2 thoughts on “The Portal”

  1. I have a love hate relationship with patient portals. When a provider as APRN. I would encourage parents to use, as easier to reach me. At the same time, I understand how busy providers are, making it difficult to always respond as quickly as they would like. Even while still working, I hated the portals, and pretty much ignored as there is always more than one and they need passwords which I frequently forget to write down. Now retired, I have been able to access my radiology results. Recently learned of small renal cell carcinoma from an MRI. I knew what it meant but shared with my sister-in-law after about 10 days. I guess I tried to pretend it wasn’t there, but what had been incidental finding of mass was now “carcinoma”. I had upcoming appointment with my primary, about a month after the MRI. Never even occurred to me to call and get it moved up. Maybe I just wanted to spend a little more time in blissful denial!

  2. Yes, portal results can be pretty scary. I’m glad they’re there, though because some doctors don’t bother calling with important results even when they’ve had them for days,

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