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I write in support of the timely article by Stephen and Sarah Duckett (“Should there be a delay in releasing diagnostic results to patients?”), which identifies the mandatory 7-day delay as a policy that warrants re-examination. The authors have laid out the foundational issues, but the problems with this delay extend even further when viewed through the additional lenses. These principles are particularly important today, as the healthcare system rightly encourages individuals to move from being passive recipients of care to active managers of their own wellbeing.
From an economic standpoint, the policy may inadvertently exacerbate the information asymmetry that is already a significant issue in healthcare. By withholding data from the patient, the system reinforces an older, paternalistic model where the clinician is the sole keeper of knowledge, making it more difficult for patients to be truly informed partners in their own care. This design has the practical consequence of creating an over-dependency on a GP workforce already under significant pressure. Requiring a consultation for every result, regardless of its complexity or urgency, establishes an artificial bottleneck. This not only impacts system efficiency but also raises questions of equity, as it can disproportionately affect those in rural and remote areas or individuals who cannot easily take time away from work for appointments.
This rigid, one-size-fits-all pathway hinders the development and adoption of smarter, more flexible models for managing routine information. For instance, a system with immediate access could support workflows where practice nurses or community pharmacists review and discuss normal or near-normal results with patients, or where digital tools guide patients through self-management for low-risk findings. Such models would free up valuable GP consultation time for the complex clinical issues where their expertise is most needed, rather than on administrative follow-ups.
Putting real patient safety first
From a safety perspective, the delay represents a system-level safeguard with significant unintended consequences. James Reason’s Swiss Cheese Model is a useful framework here. In this model, the 7-day delay is a defence, or a “slice of cheese,” intended to prevent the harm of patient anxiety from uninterpreted results. However, as the authors of the previous article powerfully illustrate, this defence contains a significant vulnerability — a “hole.” It introduces a reason why an urgent result might not be acted upon in a timely manner, allowing it to sit unread by the one person with the most at stake. While we know results are sometimes missed due to individual human factors, this policy builds a systemic flaw that makes such failures more likely by creating a blind spot. In contrast, providing immediate access effectively deputises the patient as a final, highly motivated safety barrier. This empowers them to close the loop on their own care, query results that may have been overlooked, and act as an active monitor of their own care pathway, transforming them from a passive recipient into a resilient component of the safety system.
This policy reflects a traditional “Safety-I” mindset, which defines safety as the absence of negative events and focuses on preventing errors by adding constraints and rules. A more modern “Safety-II” approach, which is a much better fit for a complex adaptive system like healthcare, defines safety as the ability to succeed under varying conditions. Instead of blocking information to prevent the possibility of patient panic, a Safety-II approach would focus on giving patients and clinicians the tools to manage information effectively. This could include linking results to plain-language explainers, using colour-coding to indicate normal ranges, and providing clear guidance on when and how to contact their GP. This fosters a system based on trust and shared responsibility, not one built on a fear of patient reactions.
Smarter risk management
The policy also forces a difficult trade-off in risk management, one that can be framed as a choice between a regulatory Type I and Type II error. The system is currently designed to prevent the Type I error: a patient seeing a result, misinterpreting it, and experiencing unnecessary anxiety (a “false alarm”). To avoid this, the system accepts the risk of a far more serious Type II error: a patient with a high-consequence, time-sensitive condition being harmed because of a delay in communication (a “missed detection”). While the psychological distress of a Type I error is a valid concern, it is often transient and can be mitigated with good information and support. The clinical harm from a Type II error, however, can be permanent and devastating.
Consider a patient empirically treated for a urinary tract infection; seeing a culture result showing the bacteria is resistant to their prescribed antibiotic would allow them to seek earlier, appropriate treatment, potentially preventing deterioration into sepsis. The system’s current preference implicitly values the management of clinician workload and patient anxiety over the prevention of tangible, and at times life-threatening, clinical harm.
The field of clinical genetics provides a useful, real-world model for a more nuanced path forward. High-stakes predictive tests, such as for Huntington disease, rightly require a process of facilitated disclosure in a controlled, supportive environment with genetic counsellors. The profound and life-altering nature of such a diagnosis means the potential for psychological harm is immense, justifying this specific exception. However, this carefully managed exception proves the rule. For many other genetic results, patients face lengthy waits for specialist interpretation, making any additional, artificial delay untenable.
This highlights the inadequacy of a blanket policy for all results. A risk-stratified approach is needed, one that respects both patient autonomy and clinical responsibility. The default should be immediate release, a standard now mandated in the United States under the 21st Century Cures Act. The focus could then shift to developing clear clinical governance to identify the small, well-defined exceptions that warrant a different pathway, rather than treating all patients and all results as uniformly high-risk. This would require collaboration between clinicians, policymakers, health informaticians, and patient advocates to define which result types require a facilitated release.
Drs Duckett and Duckett are right to call for a smarter use of technology. Let us use it not just to remove a delay, but to build a health system that is fundamentally more transparent, resilient, and truly centred on the patient. This represents not just a technical upgrade, but a necessary cultural shift towards a modern partnership between patients and their healthcare providers, built on mutual respect and the power of shared information.
Trained as a medical practitioner, specialising in metabolic paediatrics, clinical genetics and medical administration. Has held operational and strategic leadership positions in healthcare throughout Australia and New Zealand. Research interests focus on the intersection of health and social policy, particularly as they relate to behaviour and economics. Fellow of the Royal Australasian College of Physicians, Royal Australasian College of Medical Administrators, and Australasian Institute of Digital Health.