Ordering Your Own Lab Tests
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 often 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.
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.
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.
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.”
Lab Tests Online
Last reviewed May 2008 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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