Today, patients are increasingly proactive about their health, often requesting tests they can order online and perform at home. While this allows for more autonomy, it also raises questions about whether patient-driven testing adds value and if it may cause more harm than good.
If you're wondering how other practitioners are handling patient-driven testing, read the peer consults below, then log in or sign up to see the consensus and share your opinion.
A 55-year-old man with well-controlled hypertension and hyperlipidemia begins using a home fingerstick lab service that monitors hsCRP, HbA1c, lipids, and vitamin D monthly. He emails his results regularly, sometimes requesting medication changes based on slight fluctuations.
Should practitioners incorporate or discourage patient-driven testing outside of routine intervals?
Key takeaways about how to manage patient-driven testing:
Internal Medicine
"I already order appropriate interval testing for my patients. If they want to do more testing, that’s fine, but if they want medication advice or adjustments then they will at minimum need a televisit to document discussion of results and any medical changes needed. In general, I try to educate on overtesting and how it may lead to yo-yo care that is not best."
Family Practice
"I would consult the patient and express my concerns on how accurate these tests are. Before changing any therapy that the patient is requesting because of these tests, I would check the results with standardized laboratory tests. I would express my concern about reading into too many of these home tests and make sure that the patients are not changing their treatment on their own."
Surgeon
"I would discourage. No need for monthly checks of these labs. I’m already doing it in the office, so it makes no sense, especially when we do not know the quality standards of the send-out lab. What is the purpose of checking these monthly?"
Family Practice
"This is tough. I have actually encouraged patients on Warfarin to embrace home testing, and I review and respond to their results promptly, as that medication does require frequent monitoring and adjustments. That service also allows for a code and modest reimbursement for my time and documentation. I would probably ask for information about the accreditation of the lab service he is using, and ask to correlate their results with a clinical lab.
Instead of offering medication adjustments, encourage him to work on lifestyle modifications, which are better correlated with health. Explain to him that there is no physiologic reason to monitor those parameters monthly. Could also offer a telemedicine visit to address results and explain it is time-consuming to address them every month over the phone."
Nurse Practitioner
"I approach home-based testing with caution. While it's good that the patient is engaged, frequent checks of markers like hsCRP or lipids can lead to unnecessary worry or overtreatment. I don't encourage adjusting medications based on small fluctuations outside of routine monitoring unless there is a clear clinical reason.
If a patient shares results I didn’t order, I review them when appropriate, but clarify that any changes will depend on the full clinical picture. Clear communication about what is meaningful and what isn’t helps keep care focused and safe."
Unspecified/Other
"While patient autonomy and buy-in are important, this would increase costs, potentially be unreliable, and lead to patient confusion. For these reasons, I don’t agree with patient-driven testing."
Internal Medicine
"First, I’d need to know if the finger stick labs are accurate. Second, I’d want to know who ordered the blood and why they aren’t treating him. If I did decide, I would treat him based on the labs, his disposition, and willingness to follow my instructions would play a large part. If he is very proactive in his healthcare, it would go a long way towards my cooperation."
Family Practice
"Patient self-monitoring should be limited (as far as physician usage of data) to only certain markers, for example, fasting and/or postprandial glucose in diabetics. The physician should review with the patient in detail the item(s) he/she will order and the frequency of the same, which will guide his/her decision-making. In this manner, the patient has a good understanding of what to expect and why."
Internal Medicine
"I think these patients need education on the proper use of these home-based tests. Explain that the hgbA1C will take a few months to see any true change. The home results should be confirmed before recommending any medication changes. Also, healthy lifestyle changes should be stressed. Performing these tests too frequently leads to increased anxiety (without improvement of disease control).
Unfortunately, we have to review tests that were not ordered by my office. I encourage patients to contact the other providers to review them if possible."
Internal Medicine
"I think with more improved technology, we physicians will have to incorporate home tests and value pt autonomy and treat accordingly. We have valued home covid test results for some time now. Telemedicine is now here to stay. I would have him send us home test results every 3 months, encourage once a year in-person visit for physical and labs in office for confirmation, and adjust meds with home tests.
Also, with Liebre CGM systems also we have more reliable data. Cardiologists also encourage patients to get the Kardia mobile app to monitor for arrhythmias. We have to change with technology from traditional medicine. It's here to stay."
Review all consults about managing patient-driven testing, or contribute your own insights, by reading the full case on Healthcasts.