Over-the-counter blood tests prey on patients and put extra pressure on GPs, says Dr Copperfield
Coming soon to a consulting room like yours, an interaction like this:
A woman who knows she’s anaemic because the over-the-counter diagnostic blood test kit said so, twice. Which must be the explanation for her tiredness, rather than the fact that she’s a single parent with two children, running a business under huge stress, having a couple of years ago lost her husband to a serious blood disorder, who presented, yes, with anaemia, albeit not diagnosed over the counter.
So she’s ultimately pretty happy when the lab tests I arrange come back 100% normal, though it takes a good deal of unravelling the confusion, misconceptions and anxiety her self-testing caused.
Now, that’s not exactly a double-blind randomised controlled trial. But it does reinforce my notion that the new trend for OTC blood testing might represent yet another reason why we GPs are becoming increasingly reluctant to get out of bed each morning.
As does my reading of some PR blurb I saw recently announcing the arrival of yet more DIY blood tests. Apparently, this represents the ‘democratisation’ of healthcare generally and of testing in particular. Amazing word, ‘democratisation’. Democracy is so sacred that appending it to absolutely anything renders that thing incontrovertibly good, too. Though I’m not sure that logic would hold if you democratised pilots’ licences.
Besides, the ‘blood test first’ approach completely inverts the sacred diagnostic process. There’s a reason why we do history/examination/investigation, and in that order: it’s because it’s based on science and logic, and is a sequence with decreasing diagnostic return, as anyone who has spent a day in general practice, as opposed to behind a counter, will tell you.
Call me cynical, but I’m starting to think that this all-u-can-eat self-testing might be less about empowering patients and more about preying on their neurosis and curiosity, with no thought for the consequences.
Which will be that we can look forward to many more of the consultations. But that’s fine, it’s not like we’re busy. But I do object to using the NHS to mop up the fallout for tests that are meaningless, inappropriate and I didn’t order.
That’s why I think our democratically elected Government should compel the companies making these tests to fund the initial follow up of ‘abnormal’ tests through the private sector.
Then we can really see how much they like democracy.
Dr Copperfield is a GP in Essex. Read more of his blogs here
I think we should democratise Crème Brûlée because it’s lovely and we’re worth it.
Also
OTC tests will be fine when the NHS is regigged and patients pay fifty sausages for fifteen minutes of further interpretation. What’s not to like?
oh dear Mr Copperfield, you’re blood is starting to bubble. I think you should book an appoinetment to see your Tesco.
Why did you send off a blood test on your anaemic lady, though, anyway? You already knew she was anaemic, you just needed to tell her to go to the Tesco dispensary and request a bottle of ‘anaemia treatment’ and a follow-up anaemia test 3 months later. If it is no better, she should book an OTC FIT FOB test, and if that is negative repeat it annually, but if positive, book in for an OTC oesophago-gastro-duodeno-jejuno-ileo-colonoscopy; although it might be best, just to cover all bases, that she also do an OTC ‘cancer test’ (as advertised now frequently on the TV by the government, (not Tesco), and a set of gynaecological OTC tests in case it is period-related anaemia.
When I used to go through the plethora of results for a Practice I hoped that at least one would come back abnormal———-this hardly ever happened. It begs the question——-on what clinical basis were they ever ordered?
Most bloods ordered in primary care are not needed. Google the research.
If a patient wants to buy M&S food, I am not going to tell them to go to Lidl instead.
If they find an abnormal vitamin D or thyroid, great. At least they showed some interest in their own health.
“Most bloods ordered in primary care are not needed.” In today’s society, this no longer stands justified. Even as an experienced and respected quack, my opinion that there is likely nothing the matter is (in some ways quite rightly) questioned, whereas a clean bill of health on a basic blood profile is seen (often quite wrongly) as confirmation that there is nothing amiss.
And on the plus side, when the vitamin D comes back predictably on the low side, I get three months respite from the incurable TATT whilst they take their high dose vit D!
Agree
Carpe Vinum – so you buy yourself some time by doing a blood test? Again, most bloods give no real clinical benefit.
Some hypochondriacs will need reassurance, some healthcare abusers will want a repeat thyroid every month and some noctors will order them to get the patient out of their consultation rooms, but again vast majority of blood tests in primary care have been shown to make no difference to patient journeys.
How about democratisation of being Prime Minister or an MP?
The current PM was not elected by the population of the Nation.