The concept of the patient ordering a laboratory test (and receiving the result) instead of the clinician is becoming increasingly popular. It is known under several synonyms such as “Patient Directed testing”, “Patient paid testing”, “Direct Access testing”, “Patient self-requested testing”, etc., etc.
This type of testing can be argued for in terms of patient empowerment, patient privacy, cost saving for the patient, as well as convenience.
However this style of testing has never sat comfortably with me…
By taking the clinician out of the equation, there is an increased risk that the wrong tests will be requested, and equally as important, that the results produced will be misinterpreted.
Private laboratories tend not to discourage patient requested testing as it is almost always paid for by the patient themselves, and thus represents another income stream. For me however, such a practice needs to be very carefully monitored. It goes against all my medical training, and it belittles the expertise offered by the clinicians in ordering the correct tests, and correctly interpreting the results. It also removes any possibility of pre-test counselling.
And for microbiology (and infectious serology) tests, the clinician input is particularly important. For example, pre-test counselling before HIV & STD testing, the correct ordering of hepatitis serology, and the accurate interpretation of wound swab results are all clear examples amongst many of the potential pitfalls. These areas are difficult enough for professionals with years of training, never mind patients!
Patient requested testing looks as though it is here to stay, so needs to be very carefully regulated and controlled.
However good clinical practice should drive the agenda here, not patient pressure or commerce…