Another reader question:

Where can I find the result of an RA test in my lab paper?

Different laboratories format their reports differently, so the location of the information you want will vary.  Nobody can say “look at the fourth line down” for a specific test.  You probably have to slog through a lot of information to figure out what’s going on.

To complicate matters, there isn’t one specific test for RA.  Doctors can order a CBC and say with some degree of certainty, “your white count is ___.”  They can’t do that with RA.  There is no test (or group of tests) that can be ordered that will tell the doctor with certainty that a person does or doesn’t have RA.  When you hear that RA is a clinical diagnosis, that’s what it means – the diagnosis is made in the clinic, not the laboratory.

Your doctor is a clinician who must take a careful history, perform a detailed examination, then based on the evidence can try to determine what’s going on.  The diagnostic criteria for RA has changed.  In the past, people had to be well along the road to permanent joint damage before they could get a diagnosis.  The goal now is to diagnose early and treat aggressively enough that damage visible on x-rays never occurs.  I am highly in favor of early diagnosis!

Lab tests are part of the diagnostic criteria, but seronegative RA can be diagnosed with completely normal lab results if symptoms have lasted longer than six weeks and there are more than ten joints involved (as long as at least one is a small joint).  Seropositive RA means that lab tests (RF or CCP) support the diagnosis.  Tests that might be ordered if an autoimmune disease is suspected:

It is not appropriate to tell your doctor to order a specific test.  I wouldn’t much care for it if a client walked in off the street and told me how to do my job, and you probably wouldn’t either.  That makes it pretty easy to understand the doctor’s point of view on this.  You don’t have to read very many medblogs before you discover (if it isn’t intuitively obvious) that doctors don’t appreciate people telling them which tests to order.  Just explain your symptoms and let the doctor do his job.

There’s a small sticky-point here.  RA can be hard to diagnose.  Some doctors don’t realize that RF is negative in many people with early RA.  The CCP test is relatively new, and doctors who didn’t specialize in rheumatology might not know about it.  A doctor might suspect RA, order a test for rheumatoid factor, and not realize that there’s more to diagnosing RA.  This is where it pays to have a good relationship with your primary doctor so that you can return for follow-up without being blown off as a hypochondriac (unless you are one).  If you’re concerned about something, don’t make your doctor guess; say so.


Portable Ultrasound

Check out this announcement over a MedGadgets:  Toshiba’s Viamo Ultrasound Now Available in USPortable ultrasound equipment.  How cool is that?!

Now if rheumatology residents will learn enough about ultrasound to make it useful as a diagnostic tool, we might see those ancient x-ray machines replaced in private practice offices with something that is simultaneously less harmful and more sensitive.  Woo-hoo!


Requesting Test Results

Some places make it easier than others to get copies of your test results (and other medical records).

At my PCP’s office, the first time my doctor went over lab results in detail, he offered, “Would you like a copy of this?”  At the end of the appointment he handed that page to the MA and asked her to make a copy for me.  Another time my husband had some abnormal labs and the nurse who phoned offered to mail him a copy of the results.

My PCP makes it easy – it’s the culture in his office.  When I wanted more information and asked the front desk how to get copies, the receptionist grabbed my chart and said, “I can make copies for you right now.  What do you need?”  That’s for just one or two sheets of paper.  When I asked for a whole bunch of copies, I was asked to sign a release.  My doctor keeps track of stuff like that.

I appreciate his approach a LOT because it hasn’t always been so easy.

When we moved, finding a new pediatrician for my kids was difficult.  The first doctor didn’t work out.  When we left that practice, it was nearly impossible to get my kids’ records.  First I phoned and asked, but nothing happened.  Next I completed the records request form for the new doctor and his office sent it to the old doc.  Nothing happened.  I phoned again and was told that I’d have to fill out the old doc’s records release form.  Okay… Still nothing.  I phoned one last time to receive more empty promises.

Finally I wrote a letter citing specific dates that I’d previously asked for my kids’ records and closed with, “It isn’t supposed to be this hard!  What steps do I need to take to have you release these records that my children’s pediatrician has requested and I have a legal right to obtain?”  This was misconstrued as a threat of legal action, and the records were copied and sent to the new pediatrician promptly.


According to the Health Insurance Portability and Accountability Act (HIPAA), patients in the United States are legally entitled to see their medical records.  Patients are also entitled to copies of that record, including test results.  This is not either/or.  We’re allowed both a peek at the chart, and a copy.

The doctor doesn’t have to give the copies away, though.  It takes time to pull a chart, find the requested pages, make copies, then re-assemble the chart.  Paper and ink for the copy machine cost money.  Postage adds up.  Doctors are allowed to charge a fee to cover the costs associated with getting copies for patients.  One of my first jobs involved quite a bit of filing (which led to my speedy decision to attend college), so I am strongly in favor of making people pay reasonable costs associated with all this paperwork.

Just to confuse matters, in addition to HIPAA, every state has extra laws surrounding the subject of patient-access to medical records.

Confused yet?  There are some circumstances in which doctors can deny a patient’s request – for instance if the doctor believes that the patient would cause harm (to self or another) upon learning the information in question.  There are ways around that, though.  Reference the above links if you need more information.

If a simple request to your doctor doesn’t yield the desired results, check out Trisha Torrey’s How to Request Your Medical Records for some good tips.