Doctors concerned about rise in 'unnecessary' self-ordered medical tests

Doctors in New Zealand are concerned about the rise of self-ordered medical tests.
Doctors in New Zealand are concerned about the rise of self-ordered medical tests. Photo credit: Getty Images

Story by RNZ

Doctors are raising concern about the rise of self-ordered medical tests, as a new Australian study finds they have limited usefulness for consumers.

If you are willing to pay, a range of medical tests can be ordered from private laboratories without a doctor's involvement - including full blood count, cholesterol, and tests for sexually transmitted diseases. These cost anywhere from $25 to $340. 

But Dr Bryan Betty, chair of the General Practice New Zealand, told Nine to Noon that without expert interpretation, self-ordered tests can cause unnecessary anxiety and follow up.

"One of the concerns being raised here is, how are these tests being followed up once they're ordered, how are they interpreted and then how is that managed going forward, especially if an abnormal test is detected?"

He explained that if doctors order a test on behalf of the patient, they were responsible for ensuring the patient had informed consent and understood why the test was being done. If an abnormal result came back then the doctor was also responsible to go through next steps with patients such explaining the result and putting a management plan in place.

Dr Betty was worried about the anxiety self-directed tests may have for patients.

"One of the things we see with blood tests all the time, they may be slightly abnormal but in the context of the patient, in the context of what actually happens, it's irrelevant ... and we can reassure and say look we don't need to do anything to follow that up."

There were also a lot of concerns raised about direct-to-consumer advertising for medication amongst GPs.

"New Zealand is the only country in the western world that allows this, along with the USA," he said.

"We do spend a percentage of our time talking to patients about medication that may or may not be appropriate for them that they have seen advertised in the media ... that does waste resource."

Meanwhile, a recent Australian study has found the benefits of self-ordered tests to most consumers were questionable.

Co-author of the study Dr Patti Shih said the most surprising find in the study was the sheer number and variety of tests that were available.

"We found over 100 types of test that amounted to about 500 different types of products.

"The biggest group that is being advertised were so called 'health-checks' or these 'health-status tests' that looked at ... for example, hormone levels or your nutritional status. So these are not actually indicating a particular condition that a person might have, but it's simply measuring those biometrics."

There was very little scientific evidence that showed these tests were actually going to benefit an every day consumer who tested for them, she said.

Dr Shih said 17 percent of the tests being offered were "quackery". These included tests that themselves were not evidence-based or looked for conditions that were not considered conditions by the medical community.

However, she did find a small number of tests that could potentially be useful for consumers to use themselves at home.

"[They] were primarily tests for sexually transmitted infections. Generally, these conditions have a sense of social stigma attached to it, so it might actually prevent some people from going to a clinic and getting tested. Having something independently available might be useful for them."

Dr Shih did have a warning for consumers though.

"[Self-ordered tests] are giving consumers a lot of control and access but also giving them a lot of responsibility and so my message to consumer is, not only thinking about your accessibility to these tests but also ... taking more time to think about whether you actually need these tests."

Awanui Laboratories, which is 95 percent publicly funded, offers consumers extensive tests without a doctor's referral at their own cost.

Its clinical lead in chemical pathology Dr Melissa Yssel said while it was profitable to offer the tests, that was not why they did it.

"The key reason for us offering this is that we want to offer patients a clinically validated test that's run through a credited laboratory."

If a patient received a critical result, it could actually help them access healthcare more quickly, she said.

"We don't give that personal one-to-one attention for every single result but for every result that's abnormal, we will contact the patient and if there is a critical result, we personally contact the patient about the result. We always advise the patient to contact their healthcare provider and to go and discuss the result if there's any concern."