

Disintermediating Doctors: Going direct to the lab? - cwan
http://www.newschief.com/article/20091229/NEWS/912295014/1053

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phren0logy
Disclosure: I'm an M.D. (Which may impact my objectivity about why skipping
out on seeing a doctor is a bad idea.)

Without an exhaustive review of the implications of Bayes' Theorem, suffice it
to say that this isn't necessarily a good idea. The short version is: if you
are unlikely to have a medical condition, a positive result _may well be a
false positive._

Much like a full-body MRI with no medical indication, there is a risk of a
false positive leading to more expensive, unnecessary, and possibly dangerous
procedures to chase down a condition that doesn't exist.

Going "directly to the lab" is, for many people, predicated on an overly
simplistic and idealistic understanding of how lab tests work. The context of
the result (health history, family history, physical exam, etc.) is important
for accurate interpretation.

Finally, some tests border on the fraudulent. I'm a psychiatrist, and
increasingly tests to make a psychiatric diagnosis based on a genetic
screening are being marketed directly to patients. These tests are not
generally accepted in the medical community as being accurate. In fact, some
them are very likely to be totally misleading.

 _Caveat emptor._

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jluxenberg
Sure, but for something simple like an STD screen or cholesterol surely these
results are unambiguous?

The article says these tests can be _"at a cost that is as much as 80 percent
less than going through a doctor"_ , what can explain that kind of discrepancy
besides rampant corruption in the "official" medical lab work market?

~~~
phren0logy
Cholesterol: Probably. STD: Depends on which one.

Cost: I don't know why the difference is so large; that seems like a serious
problem. For what it's worth, I don't make a single extra penny on lab tests.
As far as I know, most doctors don't (except maybe the pathologist who runs
the lab). We just order what's indicated.

~~~
carbocation
I must say that I take a slightly different position on cholesterol. People
seem to have a very difficult time interpreting the different values,
particularly as most people cannot distinguish HDL from LDL from TGs. Plus,
ATP-III recommends different limits on LDL-C for patients with different risk
factors.

Would I say that the average person should be able to get a cholesterol test
if they want it? From a rights/freedom standpoint, absolutely. Would I worry
that they would misinterpret it without guidance? From a medical standpoint,
absolutely.

~~~
phren0logy
Good point; maybe reading them all the time makes me underestimate what's
involved.

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ippisl
1\. www.medindia.net $15 doctor consult with an indian doctor.

2\. personal health record.

3.expert systems for medical diagnosis / test referral.

4\. a lab-on-a-chip device , that costs a few $ , being developed by an Indian
company , that could diagnose any viral/bacterial disease.

5\. direct-to-consumer testing as shown in this article.

Combining those methods , with usual doctor visits as needed could make a very
effective combination , especially for the 1st visit to doctor , where only
test referals are usually given.

