http://cbshealthwatch.medscape.com/cx/viewarticle/411061

December 2001
Mark D. Uehling, Medical Writer

If you suspect you're pregnant or developing prostate cancer, you can take some comfort when a doctor orders a test: Answers are on the way.

Now you can cut out the medical middlepersons and order your own lab work. "With salivary testing, you'll know your levels anytime you want without a doctor's order," promises one lab, offering bodybuilders the chance to learn their steroid levels without the inconvenience of visiting a doctor. Order-your-own lab tests are legal in half of all 50 states.

One drawback: payment up front. Insurance will not cover self-ordered tests. But if you pay for a test, you control the answer. With self-ordered tests, you get more control over who can learn the nitty-gritty details than is the case with traditional tests, which can be read by your boss and just about anyone in the hospital.

Beyond the privacy factor, the turnaround time for self-ordered tests is also appealing. Rather than wait weeks for an appointment and then sit in a waiting room for an hour to get a few precious minutes with a doctor, self-ordered testing is quick--20 minutes start to finish. Answers can come in 24 hours. You don't sit there wondering when the doctor's office will call you back.

Wide 'Menu' Available
 
The variety of tests available is also comforting. Commercial labs will let patients order tests for osteoporosis, cholesterol, colon cancer, sperm count, liver function, urinary tract infections, potassium levels, even illegal drugs like cocaine and marijuana. Some tests are versions of those available in drugstores. Others are identical to those requested by doctors.

The companies that offer these tests are legitimate. Respected hospital networks like Sentara of Virginia are encouraging patients to pick their own labs and read the results in the comfort of their own homes. "You decide and pay for whatever screenings you want," Sentara claims.

Even the largest lab in the land, Quest Diagnostics, has started up a service to capitalize on the trend. Since June, the company has allowed consumers in five Rocky Mountain states to order 25 kinds of lab tests. No doctor necessary.

Patient-directed lab testing seems to be a logical extension of the do-it-yourself ethic. We hang our own drywall. How complicated could it be to order a urinalysis?

Plenty, says one doctor. J. Edward Hill, MD, is chair-elect of the board of governors of the American Medical Association. He's a seasoned family practitioner from Mississippi who sounds like the sort of gracious, kindly physician patients flock to. "This kind of self-ordering of tests has no chance of improving healthcare," says Hill. "When you act as your own physician, you have a fool for a patient. People could be significantly harmed."

Hill goes on to say that in training young family practitioners, he instructs them to make diagnoses from histories and physicals--talking to patients and examining them. Only then can lab tests be ordered judiciously. "A false positive can lead you down a trail that can not only be expensive; it can be dangerous," he says. Unneeded anguish, serious drugs, invasive tests, even surgery are examples of what might come out of a lab result that is not properly interpreted and confirmed.

Quest says such concerns are unfounded. "We're helping people to be better-educated consumers," says Gary Samuels, Quest's vice president for external communications. "By being armed with this additional information, patients are going to have more meaningful interactions with their physicians." Samuels says the company is simply responding to market forces. "We're not trying to push this," he says. "People are demanding it. They are asking for specific tests. They want data. It's like managing your finances without your bank statements." Samuels insists Quest does not want patients to avoid doctors. He says the company will help patients who lack doctors find them.

More Than Numbers
 
Some self-directed lab tests could indeed fill a niche. As many as 40% of HIV-positive people have never been tested. A storefront or Web site that prompts such people to get tested (and practice safer sex) would be worthwhile. Is more than a decade of college, medical school, and residency training necessary for a diabetic to order a hemoglobin test? No. They can order their own tests and understand the results.

However, there are situations in which the ill-considered use of a test--or even of a completely accurate result--could have unintended bad consequences. The lab industry is beginning to agree that this could be a problem, as can be seen in a warning-filled Q & A that a society of lab professionals has created. (See http://www.ascls.org/labtesting/hometest.htm.)

• Should you really try to figure out if you have hepatitis C without a doctor's help?
• What would your next step be?
• Performing your own liver transplant?
• Could the kids scrub in?
• How sharp is that carving knife?