Disintermediating Doctors: Going direct to the lab?
newschief.com
newschief.com
Without an exhaustive review of the implications of Bayes' Theorem, suffice it to say that this isn't necessarily a good idea. The short version is: if you are unlikely to have a medical condition, a positive result may well be a false positive.
Much like a full-body MRI with no medical indication, there is a risk of a false positive leading to more expensive, unnecessary, and possibly dangerous procedures to chase down a condition that doesn't exist.
Going "directly to the lab" is, for many people, predicated on an overly simplistic and idealistic understanding of how lab tests work. The context of the result (health history, family history, physical exam, etc.) is important for accurate interpretation.
Finally, some tests border on the fraudulent. I'm a psychiatrist, and increasingly tests to make a psychiatric diagnosis based on a genetic screening are being marketed directly to patients. These tests are not generally accepted in the medical community as being accurate. In fact, some them are very likely to be totally misleading.
Caveat emptor.
The article says these tests can be "at a cost that is as much as 80 percent less than going through a doctor", what can explain that kind of discrepancy besides rampant corruption in the "official" medical lab work market?
Cost: I don't know why the difference is so large; that seems like a serious problem. For what it's worth, I don't make a single extra penny on lab tests. As far as I know, most doctors don't (except maybe the pathologist who runs the lab). We just order what's indicated.
Would I say that the average person should be able to get a cholesterol test if they want it? From a rights/freedom standpoint, absolutely. Would I worry that they would misinterpret it without guidance? From a medical standpoint, absolutely.
The difference is that one is paid for by a health insurance company, and the other is paid for out of pocket by the consumer. The second group is much more price sensitive.
I'm firmly on the side of patients having access to whatever sort of tests they want without the aid of a doctor. Should they draw the wrong conclusions from those tests, well, you already said it: caveat emptor. I am not, however opposed to some restrictions on what labs can claim about their tests.
"When you hear hoof-beats, think horses not zebras."
Ordering tests for every possible condition that could cause presenting symptoms is usually not the right idea. It's a difficult problem, because sometimes it really is a zebra. That's part of the art of medicine.
But not every child with a bloody nose needs a bone-marrow biopsy. That means that a child with serious blood coagulation problem may not get one with the first nose bleed. Is that a bad call? If you are that kid, you might think so. There's no easy answer, only thoughtful trade-offs.
I'm also saying that in my experience, there seems to be a tendency for doctors to ignore the patient saying "but it has stripes". For a case in point, see http://news.ycombinator.com/item?id=668195
There are some second-order effects as well, some good, some bad. On the bad side, larger demand for tests means more waiting for everybody. On the good side, more pressure on the testing industry could lead to better techniques as well as more consumer awareness about medical testing. However the limit case still seems to be "less bad" and not actually "better than current conditions."
Absolutely false. Larger sustained demand for testing means the supply will be grown by market forces. Larger sustained demand could under some circumstances actually cut waiting for everybody if it meant being able to grow the supply past a useful economy-of-scale boundary.
The market is not a static entity. (At least until the government comes in and makes it a static entity, which I hear they're getting pretty close to. So, buck up! Soon you'll be right!)
I think it'll be at least 10 years before mental health genetic testing becomes mandated by insurance, though maybe faster if improve outcomes can be readily demonstrated. I think one of the main consequences is that NRIs are going to be more widely prescribed than they are right now, because of mutated BDNF genes. http://jama.ama-assn.org/cgi/content/full/296/13/1609?maxtos...
I of course agree with you about the presence of doctors in these processes. Genetic testing is only really meaningful when interpreted by the doctors in the context of all of the other important information.
2. personal health record.
3.expert systems for medical diagnosis / test referral.
4. a lab-on-a-chip device , that costs a few $ , being developed by an Indian company , that could diagnose any viral/bacterial disease.
5. direct-to-consumer testing as shown in this article.
Combining those methods , with usual doctor visits as needed could make a very effective combination , especially for the 1st visit to doctor , where only test referals are usually given.