Do-It-Yourself Health Care

I was debating merits of DIY healthcare with my buddy, Brian Klepper, PhD -healthcare analyst and pundit extraordinaire – the other day. He is not a fan, preferring instead to have better, stronger, more informed, technologically enabled physicians working in accountable care organizations. I am also a big believer in ACOs, patient-centered medical homes, and informed physicians, and all that stuff, but I think increasingly health care consumers (aka patients) are going to want to control more of their healthcare than they are currently able to do today.

The internet has made medical information more accessible than ever before. People with serious illnesses and/or chronic diseases sometimes end up knowing more about their condition than their physicians. But reading and understanding a medical condition is only scratching the tip of the consumer empowerment iceberg. What I am really interested in exploring is how technology can be used to further drive a true “consumer-directed healthcare” revolution.

Now I want to make it clear I am not proposing that people do their own surgery (although some have done it). Nor am I proposing self-prescription of expensive and/or potentially toxic therapeutics. But I am talking about consumers being able to order their own lab tests without involving a physician…and self-prescription of certain categories of medications (e.g.,statins).

Consumers are already doing some of these things. For example, diabetics routinely test their blood glucose at will. For years, women have been diagnosing their pregnancies via home pregnancy tests. Hand-held devices are available in most drug stores and online to measure hemoglobin A1c, cholesterol levels, test for a UTI and even screen your urine for drugs before you go for your pre-employment drug testing. There is now a FDA approved test for HIV (you draw the blood at home and send it into the lab).

Several companies are on the market that allow consumers to order a wide variety of blood tests, at a relatively modest price, and then go to a local affiliated lab for the blood draw, and then go to a local affiliated lab for the blood draw – all of this without involving a physician. The tests come with interpretation, but if you want to learn more about your tests and what they mean, there is a website that can help you out.

Gadgets are also readily available for consumers to monitor blood pressure, heart rate and fetal heart sounds. You can buy home defibrillators, portable interpretive EKG machines, and portable ultrasonic ultrasound devices for pain relief. You can stock up on stethoscopes, otoscopes and opthalmoscopes and reflex hammers. Right now, for a price, your bathroom can be as well equipped as your average PCP’s exam room.

Sure, you are saying, but who wants to do that? Well, the answer is some folks do want to do it. Here is a sampling of consumer comments from an online merchandiser that sells medical devices direct to consumer:

“Love the Otoscope! Very easy to use. My daughter has special needs and is prone to getting ear infections, since she cannot communicate it is very hard to determine what is going on with her. No more guessing, can now look in her ears and can determine if she has an infection or not. No more waiting for 3-5 days for the doctors office to see her to check her ears.”

“Since my husband’s family has a history of heart disease, I thought I would look into getting one of these. In researching the topic at the Consumer Reports website, I found that they reported that the resuscitation rate nationally is 2 to 5%. With a Home Defibrillator, the rate jumps to 40 to 50%. In researching further, I found that the Phillips is the only Home Defibrillator available to buy w ithout a prescription. The website for this product, www.heartstarthome.com, has a wealth of information. They offer assistance in finding out if insurance or Medicare will cover some of the cost of this product…I was very impressed with the amount of on-line support at www.heartstarthome.com, including a video and a demo. The demo shows exactly how the product works. It removed all doubt about whether I would be able to use this product. (Obviously, taking the American Heart Association class is highly advisable!) Thanks, Philips.”

“Being a 1st time mom and a diabetic, I fall into the “High-Risk” category. I was constantly in an anxious state. I wanted peace of mind. After looking at dopplers all over the internet, I found most of the good ones to be astronomically priced. One day, I stumbled onto this site and read all the reviews. I figured I’d take a chance so I ordered my Angelsounds Doppler. As soon as I got it, I ran into my bedroom, slathered some oil on my tummy and began the exploration. Within 3 minutes I heard that distinctive “swoosh” sound. I am nowhere near being a small girl. I was plus-sized before I was even pregnant. I’m only at 14 weeks so I was EXTREMELY impressed by the volume of the heartbeat and the ease in finding it. I HIGHLY recommend this doppler. I have been able to sleep soundly ever since I purchased it. You won’t regret this purchase!“

Or this one:

“I’ve already recorded, downloaded and printed a few baseline EKG’s on myself and others and I must say that I’m somewhat impressed with this unit. It seems to be the only one I’ve seen for the price that contains everything you need to get started right out of the box. The only thing you might need is more ekg pads if you intend to use the unit with the 3 wire plug connection. It comes with 3 EKG pads to get you started. I recommend this unit to anyone interested in learning about cardiac, small Doctors offices that want a quick snapshot of their patients and to those that want to keep a record of their own heart condition for their Doctor to diagnose when visiting their office.”

As these technologies improve and become cheaper, I suspect you will see more consumers becoming fans of DIY medicine. This is not to say that every consumer will want to be their own doctor. Nor is it to say this strategy is completely risk free. Opponents will argue that self-diagnosis and monitoring could lead to misdiagnosis, delays in diagnosis, and a false sense of security. True…but getting these tests in a doctor’s office is no guarantee that you will get the right diagnosis at the right time everytime. If DIY medicine does take off, you can be sure some entrepreneur somewhere will grow a business by providing low-cost, rapidly available advice and counsel to support the do-it-yourselfers.

As consumers take charge, by-passing both traditional physician office visits and health insurance, it is just possible that a real market for these services can be established – driving costs down and quality up in a quest to provide value to the paying customer.

Patricia Salber, MD, MBA is Principal at PRS Strategic Healthcare Consulting.  Prior to that she served as EVP and National Chief Medical Officer for Universal American’s Medicare Advantage Plans.  Other prior positions include Medical Director for General Motors and for CalPERS (through Blue Shield of California). This post marks the revival of her blog, The Doctor Weighs In.

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5 replies »

  1. For the benefit of anyone who still may stumble onto this old blog:
    I believe pharm companies would like it if people could self-prescribe meds… and if they like something I feel I should take a second look to see if I still like it.
    There already are meds you can self prescribe, and they’re not dangerous either. They’re called over-the-counter medications. If statins belonged in the “self-prescribe” category, the pharm companies would push for that and it would happen.

  2. I’ve got mixed feelings on this one. A family I knew had a young son who would experience seizures when his temperature spike too high. The first time it happened was very traumatic and led to a scary ambulance ride to the hospital. Afterwards, the doctor told the boy’s mother that if she caught the fever in time she could cool him down at home and avoid the seizure and hospital trip. Ear thermometers had just come on the market for private use; even though they were expensive, this little device allowed the family to carefully monitor the boy and keep his temperature down, avoiding regular trips to the ER. That’s just an ancedotal example of the difference home testing and treatment can make to one family, and I’d bet there are more out there like it.
    On the other hand, where is the line where patient testing can become dangerous, and does home testing always equate home treatment? Most women who use pregnancy tests go on to schedule a visit to the OBGYN.
    Trying to decipher bloodwork would be like reading Greek for me (and I’d wager the majority of patients). Even if I was able to find a website that explained part of it, I’d feel better if a doctor looked it over. Now, here’s the real question: if a doctor uses a patient-ordered test (rather than one made through the office), how much liability is incurred? Like it or not, fear of malpractice suit is real: where does DIY testing and care fall on the litigation landscape?

  3. I believe that if people know their own body well, know how to listen to it, and are knowledgeable about medical issues then taking a lot of it into ones own hands is a wonderful idea.

  4. Leave it to the Society of Dark Arts :Health Care.Do it yourself Health Care? Average Citizens having a license to Kill. You Know 007! Like in James Bond.
    No need for a licensing Board. After all there are enough Hacks in practice today.
    DIY would not entitle you the same protections of 007 simply because of the endorcements,licensing boards,federal and state protections that(will Not) exempt you of prosecutions.
    Informed Choices and transparency would be make great strides in providing better Care!

  5. I would be interested to see how much of “self diagnosis” movement leads to better outcomes, ie, engaged, vigilant patients vs overuse, overtreatment with excessive doc and clinic visitations and/or nuisance calls.
    I would not assume this is all good (or bad). We need CER for this kind of technology. My inclination is the net effect will be a wash, and more affluent patients will buy equipment with a mixed bag of results.