What should you do when you misinform the Laboratory Results?
Viroj Wiwanitkit MD*
Affiliation : * Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330
The author had an opportunity to address, in a classroom discussion, one of his student’s questions on what a
physician should do if he/she misinforms a patient about laboratory results. This question then became a discussion topic in
the classroom. The two main answers from this discussion were:
1. Most of the students tried to convince the patient of the necessity of re-examination and asked the patient to repeat
the test. The main reason was the result(s) of the first examination was/were questionable and a confirmation test was required.
2. Some of the students suggested doing nothing about the problem.
Key ethical dilemma
The author would thus like to raise this question to permit readers to think about it. In the author’s viewpoint, the
two answers can imply some interesting topics:
1. Most students used the questionable first result as the reason for asking the patient to have the test repeated. This
seems better than doing nothing. However, can this alternative be successful? Is it an attempt to transfer fault to others,
especially to the medical laboratory? The patient might ask why the first test failed, and how the repeated test would be
validated. If the patient were to accept the repeated test, who would be responsible for the laboratory charge? Furthermore,
if the repeated test is successful, will physicians feel bad? Is this lying(1)?
2. It is a notable finding that a number of students selected “do nothing”. If there is no problem, this alternative may
be a good choice. However, in an unlucky case where a problem occurs, the physician in change may be sued and there might
be bad publicity.
3. Why “acceptance of a failure” is not a selected choice? Explaining the failure might be better than lying. Problems
might not exist following an “apology”. Many problems are due to “not accepting the truth” and “hiding the guilty”. Sometimes,
someone selects to use a more shameful method “raising their previous goodness” to cope with the overt guilt such as saying
“I have performed with goodness all of my life. This is my first case of guiltiness”. In authors’ views, this is an unacceptable act.
In the author’s view, acceptance of the failure, analysis of the root cause so to prevent recurrence, and an apology
to the patient seems to be a better way. To establish this moral level, education from the time the student enters medical school
is necessary.
In addition to addressing the issue from the author’s viewpoint, the author would like to address it from the
theoretical perspective. The discussion on how the Kohlberg’s stages of moral development(2,3) apply to this ethical issue is
given in Table 1. It seems that the responses from physicians, at different stages of moral development to this situation, are
variable.
Nevertheless, the ethical and practical implications can vary widely depending on what “telling incorrect labora-
tory results” means. Their meaning can range from advising of inaccurate test results, of the correct test results with incorrect
interpretation of the results, and advising of the correct test results with correct interpretation to an incorrect person, etc. The
clinical consequences of telling test results to a patient that might be significantly different from the real test results may be
great. Genetic testing, autopsy, prenatal, and HIV examinations are ethically the most problematic laboratory examinations(4,5).
Recommendations
Besides discussing how to handle the situation from one personal perspective, one can further survey physicians,
medical students, residents, or medical faculty members to demonstrate how the Thai medical community feels about this
issue.
Keywords : Misinform, Laboratory, Result
