If by "consumers" you mean the same people that play the lottery as a retirement strategy, then this is a definite NO. Without a basic understanding of the effect of the prior probability of an abnormal result, interpreting the result of a test is impossible. Remember that ALL laboratory tests have a non-negligible false positive rate. Chasing after false positive laboratory results can lead to major harm. As reported in the NYT regarding the mandatory premarital HIV testing program in IL in the late 1980's found "People getting married, who are unlikely to be homosexual or particularly prone to drug abuse, are among the least likely to be infected. In addition, screening a population at low risk for a disease, even with a highly accurate test, produces an unacceptable share of false positives. If Illinois should ever find 100 marriage applicants who test positive by both AIDS tests, perhaps a third of them would have been falsely diagnosed." see: http://www.nytimes.com/1988/02/01/opinion/aids-marriage-and-folly-in-illinois.html
I don't think the general population is ready to face the unintended consequences of these false positive results.
Nick - 9 years ago
They should be able to, however, they should understand the costs associated with the tests.
Donald Gilchrist - 9 years ago
Risk of patients not understanding testing results and then harming their health with improper treatment is, in my opinion, a new or major problem. People have been doing self diagnosis and treatment for years. Mass media, TV and Internet, only tends to exacerbate the problem with questionable information represented as fact. Responsible patients will use the no order testing and results as an adjunct to services provided by qualified medical staff.
Another potential benefit is for persons who may be reluctant to discuss certain medical problems with a care provider before ascertaining that it is a problem, such as STD's.
I utilize the service to check progress on some indicators between 3 to 6 month Provider appointments and would also use it if a certain condition was of personal concern.
BarCode - 9 years ago
A qualified yes, but significant work needs to be done in the laboratory community to reform reference ranges and flagging. Many clinical lab tests flag the top and bottom 2.5% of the population as abnormal. There is no scientific basis for this. A more logical approach requires knowing what question the requester is asking (e.g. "Do I have Graves disease?") and whether symptoms are present. Without these two pieces of information, the average consumer is not well served by the assumption that only the central 95% of the population is "normal". Using a central 99% reference range would be a better default for tests where there are not evidence-based cutoffs defined.
Mak - 9 years ago
re: HIT Geek's comment "and pay for it themselves": My answer would still be a resounding "YES!!". I've been in the position of begging wimpy doctors to order specific tests beyond the sparse panel that is currently recommended by the "experts" and the health plan. Offering to personally pay for these tests is what finally got the job done and eventually confirmed my suspected diagnosis. The test results uncovered evidence of a genetic, treatable condition. This knowledge greatly benefited me and will also benefit my children and grandchildren, as 50% of my offspring will likely inherit the condition.
HIT Geek - 9 years ago
The question is incomplete. Add "and pay for it themselves, not using health insurance." I'll bet the results would be different.
dzamd - 9 years ago
Yes. The prohibition against practicing medicine without a license is a patronizing and vestigial concept. Apropos, one may represent oneself in court without a lawyer. Expect similar results.
If by "consumers" you mean the same people that play the lottery as a retirement strategy, then this is a definite NO. Without a basic understanding of the effect of the prior probability of an abnormal result, interpreting the result of a test is impossible. Remember that ALL laboratory tests have a non-negligible false positive rate. Chasing after false positive laboratory results can lead to major harm. As reported in the NYT regarding the mandatory premarital HIV testing program in IL in the late 1980's found "People getting married, who are unlikely to be homosexual or particularly prone to drug abuse, are among the least likely to be infected. In addition, screening a population at low risk for a disease, even with a highly accurate test, produces an unacceptable share of false positives. If Illinois should ever find 100 marriage applicants who test positive by both AIDS tests, perhaps a third of them would have been falsely diagnosed." see: http://www.nytimes.com/1988/02/01/opinion/aids-marriage-and-folly-in-illinois.html
I don't think the general population is ready to face the unintended consequences of these false positive results.
They should be able to, however, they should understand the costs associated with the tests.
Risk of patients not understanding testing results and then harming their health with improper treatment is, in my opinion, a new or major problem. People have been doing self diagnosis and treatment for years. Mass media, TV and Internet, only tends to exacerbate the problem with questionable information represented as fact. Responsible patients will use the no order testing and results as an adjunct to services provided by qualified medical staff.
Another potential benefit is for persons who may be reluctant to discuss certain medical problems with a care provider before ascertaining that it is a problem, such as STD's.
I utilize the service to check progress on some indicators between 3 to 6 month Provider appointments and would also use it if a certain condition was of personal concern.
A qualified yes, but significant work needs to be done in the laboratory community to reform reference ranges and flagging. Many clinical lab tests flag the top and bottom 2.5% of the population as abnormal. There is no scientific basis for this. A more logical approach requires knowing what question the requester is asking (e.g. "Do I have Graves disease?") and whether symptoms are present. Without these two pieces of information, the average consumer is not well served by the assumption that only the central 95% of the population is "normal". Using a central 99% reference range would be a better default for tests where there are not evidence-based cutoffs defined.
re: HIT Geek's comment "and pay for it themselves": My answer would still be a resounding "YES!!". I've been in the position of begging wimpy doctors to order specific tests beyond the sparse panel that is currently recommended by the "experts" and the health plan. Offering to personally pay for these tests is what finally got the job done and eventually confirmed my suspected diagnosis. The test results uncovered evidence of a genetic, treatable condition. This knowledge greatly benefited me and will also benefit my children and grandchildren, as 50% of my offspring will likely inherit the condition.
The question is incomplete. Add "and pay for it themselves, not using health insurance." I'll bet the results would be different.
Yes. The prohibition against practicing medicine without a license is a patronizing and vestigial concept. Apropos, one may represent oneself in court without a lawyer. Expect similar results.