Do-it-themselves diagnosis: Patients pick their tests

Direct-access testing allows patients to choose and administer health tests that once required a physician's order. Is it the wave of the future?

By Stephanie Stapleton, AMNews staff. May 5, 2003.

You walk down the hallway toward the exam room where your next patient waits. You grab the chart, give it the usual review, knock twice on the door and enter. But something is different. The patient inside has brought lab results from tests she ordered herself. The findings show that one value falls beyond the normal range. She's worried, and that's why she scheduled this appointment.

What do you do now?

If some in the forecasting business are correct, that's a scene that primary care physicians will confront more and more often. These forecasters see momentum building for direct-access testing -- a service in which consumers pay out of pocket to have a variety of screening tests without ever having to speak to a physician. It's a development driven by state regulatory changes, market forces and the advent of empowered health care consumers.

And it is triggering debate within the medical community.

Proponents of direct-access testing say the service is an important part of personal wellness. It is designed not to supersede the doctor-patient relationship but to enhance it, making it possible for people to actively monitor chronic conditions or particular health concerns.

But some physicians worry that it may cause harm. Whose responsibility is it if a lab result is abnormal? Who is there to put the findings in the overall context of the patient's medical history? Who steers the follow-up decisions? Some doctors say it casts them to the sidelines.