It used to be that patients would have to go see a doctor to get lab tests ordered to check their cholesterol or metabolism, but now, thanks to at-home testing companies like Everlywell, those tests (and 30 others, including STI tests) can be ordered online or picked up at some big box retailers. We chatted with Dr. Frank Ong, Everlywell’s Chief Medical and Scientific Officer, about what it means to put patients in charge of ordering their own lab work — and combing through their own testing results — vis a vie the Everlywell platform. As consumers demand more control over their healthcare dollar and the experience it buys, is there a point where patients risk getting in over their heads? How have doctors been responding to patients who come in armed with their own lab results? We check in on how at-home testing kits are ‘testing’ the reaches of patient-led care.
I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work helps. A couple of weeks ago, they published their results.
It turns out that in about 90% of cases, it didn’t matter.
A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades was almost always all that was needed to get a diagnosis. As one of the doctors in the study put it, “basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases.”
The conventional wisdom is that doctors – at least in the U.S. – order extra tests to protect themselves from getting sued. But this study was done in Israel, where the problem of medical malpractice is nothing like it is in the U.S. American-style defensive medicine can’t be the reason doctors in Israel use so many diagnostic tests.
With computerized health systems, physicians can place orders as easily as they can shop online at Amazon.com. Just a few clicks and your physician can purchase a panel of blood tests, futuristic imaging and diagnostic procedures that will hopefully guide their path to solving your ailments.
Search. Click. Submit. Repeat.
Except, unlike online shopping, physicians don’t see the price tags and they never get the bill. Doctors are the true consumers of health care dollars, but the rules of economics falter when the consumers aren’t the ones that pay up. This disconnect is a fundamental cause of the uncontrollable inflation of health care costs in the US. Ignorance about cost fuels spiraling inflation in healthcare because without cost-related restraint in utilization there is no incentive for suppliers of healthcare services to get any cheaper.
But the system’s stuck. While physicians ultimately control the tap of healthcare costs, exerting that control can contradict their primary objectives. Physicians feel a responsibility to do the most they can to make the patient in front of them better. If young doctors don’t order a test, a superior may berate them for not considering it in their differential. Malpractice always lingers as a consequence for a diagnosis missed. Some claim that it is irresponsible or unethical for physicians to consider cost in their clinical decision making. Perhaps good doctoring should be blind to finances. And after all, it’s no skin off the doc’s back to just click a little more, some of that money may even end up back in their own pockets.Continue reading…
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