What matters to patients about diagnostics?

What matters to patients about pathology results? Two talks over recent days have brought this question into sharp focus. First Joan Saddler talked from the perspective of a patient representative. Patients need to know

• why is a test being done (or not done)
• when will the result be available?
• what does the result mean?

So for me we have to think about the consent process (do patients /their carers understand the point of a test? Have they thought about what they will do with a result? Were other actions at this requesting decision point considered/correct?)

In terms of result availability, we need to think about whether necessary information available at time of key decisions. Was this information error free? Was there a predictable flow?

In terms of results there is a lot to do! We need to think about how we convey information in a way that informs decisions. (Was an appropriate action taken as a consequence of receiving the result?) This will include much more thought as to how we define and then convey inherent uncertainties in test results - if these are important when assessing options for action. If there is a 10% variability in creatinine measurement, how do we relay this? How do we deal with variation between laboratories? We cannot transfer uncertainty without considering how patients want this to be done. It will almost certainly be different for different patients.

And today listened to Bertie Squire talk about management of TB in Tanzania. A diagnosis of TB can account for 90% of a person's annual income - and this is with free access to medicine. It is important to get this right. Diagnostics may be expensive - but they are a tiny party of the system cost. This is why this work on delivering value is important. It is actually a matter of life and death.