I'm writing about "Abnormal Pap Results: Dropping the Ball" (Legal Questions, September 2004). As a gynecology case manager in a busy office, I'm responsible for contacting patients who have abnormal test or lab results. Here are the steps we take:

1. The physician or nurse practitioner reviews any abnormal test or lab result. If contacting the patient is recommended, she notes that on the lab report and gives it to me.

2. I attempt to telephone the patient. If I get a message center or answering machine, I leave only my name, title, and office phone number.

3. If I can't reach the patient by phone, I send a letter.

4. If she doesn't respond in 2 weeks, I send another letter.

5. If she doesn't respond to the second letter, I send an outreach worker to her home to find out why she hasn't contacted us.

6. If all steps fail, I send a certified letter to her house. This letter says, "This will be our last attempt to contact you regarding abnormal test results."

We document every attempt to contact the patient and put copies of letters in her chart. I recommend a protocol like ours to legally cover practitioners who are trying to provide the best care.