Upsetting to Get Test Results From Computer

If you have Patient Gateway or another patient portal, it can be useful for appointment reminders. It’s especially valuable if, like I do, you have a lot going on and want to double-check an appointment time.

Getting electronic skin cancer results

I rarely check the section for test results. I would rather get this information from my doctor. Medical terminology can sound scary if you don’t totally understand what you’re reading, and so I choose not to delve into it.

Therefore I was unpleasantly surprised when the system spit out the results of my skin biopsies before the doctor called me. I wouldn’t have gone looking for it, but I got an email saying I had new test results to view. I already figured I had squamous cell cancers because my “radar” had detected them, and I had been to the dermatologist for biopsies. Four spots were in question, though, and I didn’t know if I would need surgery on all of them.

The electronic test results read:

• A. SKIN, LEFT TEMPLE, SHAVE BIOPSY:
  SQUAMOUS CELL CARCINOMA IN SITU with adnexal extension, present at deep margin.
• B. SKIN, LEFT ZYGOMATIC CHEEK, SHAVE BIOPSY:
  SQUAMOUS CELL CARCINOMA IN SITU, transected.
• C. SKIN, LEFT PREAURICULAR CHEEK, SHAVE BIOPSY:
  SQUAMOUS CELL CARCINOMA, invasive, transected.
• D. SKIN, RIGHT POSTERIOR NECK, SHAVE BIOPSY:
  SQUAMOUS CELL CARCINOMA IN SITU, present at side and deep margins.

And the telltale line: This test result has been released by an automatic process.

On the positive side

Looking at this in a positive light, I learned some new terminology: “zygomatic” cheek and “preauricular” cheek. The zygomatic bone is the cheekbone, the diamond-shaped bone below the eye socket, at the widest part of the cheek. Preauricular means “situated or occurring anterior to the auricle of the ear” according to Merriam Webster.

Confusion and concern

But in total, it was a case of TMI: too much information. I got particularly hung up on spot “C”: invasive.

Now, I know that invasive means just one layer down and not invasive into my body. But I like to be reassured and have the doctor re-explain it to me. I’m extra sensitive because I had a friend who died after a squamous cell cancer on her tongue invaded her whole body.

New doctor and new process

The doctor who did the biopsies was not my regular dermatologist; she could not fit me into her schedule. I thought of emailing her to say how unhappy I was about the way I got the information. But in talking to a friend, I realized that would not be productive. My friend asked what would I hope to accomplish? If it was to get more information, fine. If it was to blow off steam, maybe think about it.

I called the office of the dermatologist who did the biopsies. The nurse said the doctor would call by the end of the day. I had things to do, so I went and did them.

Clarity on the electronic results

Sure enough, the doctor called near the end of the day. She said she was sorry the system did that, and she would look into it because it wasn’t supposed to happen that way. She clearly explained it all to me and wrote a more readable summary, like so:

“Hi Ronni,

Below is a summary of your results and the plan.
A. Left temple (middle of the three lesions we biopsied on the left side of your face): squamous cell carcinoma in situ with adnexal extension - I recommend Mohs surgery.
B. Left zygomatic cheek (the lesion on your left cheek that is the farthest away from your ear): squamous cell carcinoma in situ - we can treat this with one of the topical regimens after you heal from your Mohs surgery for sites A and C (i.e. the other sites on your left side of your face). The topical regimens are either Efudex + calcipotriene twice daily for 10 days or Efudex alone twice daily for 4 weeks.
C. Left preauricular cheek (the lesion close to your left ear): squamous cell carcinoma - I recommend Mohs surgery.
D. Right posterior neck: squamous cell carcinoma in situ - given the size of the lesion, I recommend Mohs surgery.”

I’m not happy about getting more surgery but I’ve calmed down about the way the news was delivered.