by Debra Wood, RN
Are diet changes producing the desired cholesterol levels? Has your family’s
health history put you at risk for a serious illness? How are your medications
affecting your body?
For years, the answers to these questions depended on a physician ordering a lab
test and explaining the results. But now several companies offer consumers the
opportunity to test without a prescription.
“It lets me take charge of my health care,” said Debbie Wells of Buna, Texas.
She and her husband order their own annual screening tests. “I take the results
to my doctor and say, ‘We need to address this.’”
Her doctor reacts well but will order blood work only when symptoms occur,
according to Wells. Wells would rather not wait, convinced the earlier you find
a problem—such as her husband’s kidney disease—the better.
“My husband would have had more severe kidney damage if we hadn’t caught it,”
Wells said about self-testing.
How self-testing works
Consumers request the tests they want online or by phone and receive a form
to take to a local lab, where blood is drawn or a urine sample is collected.
Labs performing the tests are the same ones used by hospitals and doctors’
offices. But self-ordered tests cost less than the normal fee. For that reason,
Texas cardiologist Christopher Kopecky, MD, and primary care physician Gregory
Jackson, MD, suggest self-pay patients use direct-to-consumer labs to monitor
cholesterol, C-reactive protein, lipids, and other measurements.
“Patients are interested in their medical condition and want more frequent blood
tests than their insurance company will allow,” Dr. Kopecky said. “I’m delighted
if the patient is motivated enough to monitor frequently and stay after it. It
prevents progression of heart disease.”
Results arrive by mail, fax, or Internet. Reports compare the person’s values to
a reference range, which aids in determining whether the results are within
normal limits. Consumers also usually receive basic information about the tests
and are encouraged to share results with their doctors.
Monitoring meds
Many consumers test in collaboration with a doctor. New Yorker Dottye Howard
checks her thyroid hormone levels after medication changes or when symptoms
occur. She takes two drugs to manage her thyroid condition. Her doctor feels the
tests are necessary and uses the results to change drug dosages. But Howard’s
insurance will not pay. Howard admits testing pinches her budget, but she feels
it is crucial.
“These tests are essential pieces of a puzzle—how to optimize my meds and make
me feel the best I can with this condition. Without it, you’re guessing,” she
said. “I’m a proactive person and, happily, have a doctor that welcomes that.”
Other tests help patients taking medications monitor their drug levels or check
for drug-related side effects such as liver or kidney problems.
Screenings
A family history of disease prompts some folks to contact the labs.
Suspicious he could have hereditary hemochromatosis, Joe Wills ordered screening
tests. Positive results prompted the Gainesville, Florida man to seek care from
a hematologist. Wills gauged his treatment progress weekly, saying, “It gave me
lots of peace of mind checking it that often.”
Patients, like Wills, sometimes meet with resistance when asking doctors to
check for this treatable disorder.
“[Self-testing] has literally been a lifesaver,” said Sandra Thomas, president
of the American Hemochromatosis Society.
Control issues
Many doctors balk at people ordering their own tests.
“My concern is objectivity and knowledge level,” said J. Edward Hill, MD, a
Tupelo, Mississippi family practice physician and chair-elect of the American
Medical Association Board of Trustees. Some of the issues that worry Dr. Hill
about self-testing include:
- Proper interpretation of test results
- False positives that trigger unnecessary worry and additional testing to
determine the cause
- False negatives that give patients a false sense of security and cause
them to postpone needed medical care
“The medical implications of a patient trying to interpret a test result is
questionable,” said Dr. Hill, “because we go to school for years and years to
learn how to interpret medical knowledge.”
Other doctors applaud patients’ initiative and go over the reports with them.
“I don’t think people should have lack of access to anything,” said Dr. Jackson.
“Your biggest strength is giving patients freedom.” Dr. Jackson’s collaborative
style encourages active patient involvement. He finds people become more
motivated when monitoring their progress. “The more they learn about what they
have, the more they become participants in their health care, not victims,” Dr.
Jackson said.
Self-testing offers health-conscious patients improved assessment and monitoring
opportunities. However, they should ideally be used under a doctor’s
supervision. Self-tests should complement rather than replace a physician’s
care.
“We’re not doing an end run around doctors,” Howard said. “We need and want to
work with them. This is just another tool.”