Patients are diagnosing themselves with home tests, devices and chatbots
People increasingly turn to do-it-yourself healthcare, including blood tests and heart monitors, amid long waits for medical appointments and a rise in self-care options.
Healthcare is fast becoming a do-it-yourself project for patients.
With a shortage of doctors, long wait times for appointments and an increasing prevalence of chronic diseases such as diabetes earlier in adulthood, patients are taking a more active role in managing their own health.
In the United States now, patients are shouldering responsibility for diagnosing their own symptoms, tracking their own medical data and even ordering their own lab tests.
The challenges aren’t unlike those of managing one’s own financial portfolio: vetting sources of information, evaluating new products and making informed decisions about complex topics. In today’s fast-evolving healthcare landscape, AI and other new technologies and services are emerging to help patients find and act on medical information.
The DIY health trend brings risks like relying on diagnostic and treatment information that hasn’t been reviewed by a clinician, says Dr Tom Delbanco, a professor at Harvard Medical School whose focus is primary care. But he sees significant benefits. “The evidence shows that the more a patient gets involved in their own care, the better the outcomes,” he says. “In the future, primary-care doctors could act more as expert consultants rather than paternalistic bosses to patients.” Here are some of the most important developments shaping the new patient paradigm—and precautions that come with using them.
Ordering your own tests
Companies that process lab tests for doctors, like Labcorp and Quest Diagnostics, have been expanding the range of tests they offer directly to consumers in the US. Quest, for instance, offers more than 150 tests ranging from a $US29 ($44) complete blood count, which helps identify anemia and other blood disorders, to specific blood tests for micronutrient deficiencies and tests for several sexually transmitted diseases.
Quest says among its most popular tests is a $US385 comprehensive health profile that analyses more than 75 markers including those related to heart, kidney and liver health, as well as diabetes risk. It includes an evaluation taking in family history, lifestyle, and wellness behaviors, and creates a health-risk score ranging from 1 to 100.
Most blood tests involve blood drawing at a Quest service centre, but consumers can also pay $US79 for an in-home appointment from a mobile phlebotomist in some markets.
The company is responding to demand by patients who want to be more involved in their care and control their own data, says Quest chief medical officer Dr Yuri Fesko. Quest contracts with physicians who must review and approve orders; they are also available to consult on the results. With a shortage of both primary-care doctors and specialists, Fesko says, the consumer-ordered tests can help identify those most in need of follow-up and identify red flags early. Both Labcorp and Quest encourage patients to follow up with their own physician to review results and determine any next steps.
More companies are offering wellness plans and supplements directly to consumers based on data from blood tests, DNA analysis and data from wearable devices. A 2023 study of 21 companies that offer direct-to-consumer tests cautioned that the trend raises ethical issues, including the use of personal data and the potential lack of follow-up for abnormal results.
Anna Wexler, an author of the study and assistant professor of medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine, says consumers should stick to tests that have been shown to give reliable results. Tests that claim to estimate biological age, identify food sensitivities, and predict fertility, for example, often don’t meet validated clinical standards and may mislead consumers or lead them to buy products that they don’t need, she says.
Wearables and devices
Technology is growing beyond the already-popular use of smartphones or smartwatches to track steps per day, sleep quality or heart health. Roughly two-thirds of respondents in a recent survey of 1653 adults by the Annenberg Public Policy Centre at the University of Pennsylvania said they used such apps to track health information. Patients with atrial fibrillation can now monitor their heart rhythm with a do-it-yourself electrocardiogram on devices that interface with a smartphone app and range from $US79 to $US129.
New devices can screen for sleep apnea, measure blood pressure without arm cuffs and detect early signs of illness. In development are “smart mirrors” that use sensors, displays and software to monitor changes in appearance, mood or vital signs while patients are brushing their teeth and getting ready for the day.
Data privacy is a concern. In one study by UK researchers, participants with health conditions like multiple sclerosis and stroke said they would be interested in a smart mirror that would help them manage their symptoms and offer support – if they had control over who used the data.
Devices are becoming better at not only tracking symptoms but predicting their onset. For patients with respiratory diseases like asthma, researchers at the Georgia Institute of Technology used AI to develop a wearable patch with a seismometer microchip that can detect tiny vibrations or wheezing sounds that could signal the need for treatment. Studies by the Georgia Tech group, including one published in March in the journal Nature, showed it to be highly accurate. Such patches could be used for home monitoring by transmitting data to the patient’s doctor, the researchers said. A spinoff from the university is commercialising the patch with federal funding.
A special home phototherapy device to treat psoriasis is as effective as going to a doctor’s office for the therapy, according to research funded by the National Psoriasis Foundation. Patients also used the treatment more consistently and had fewer indirect costs such as travel and time off from work. Some insurers are already covering the home treatment, and the foundation is supporting expanded coverage.
The AI chatbot
Both patients and caregivers are turning to ChatGPT and other AI chatbots for help diagnosing symptoms, managing chronic diseases, getting advice on exercise and nutrition and researching treatment for serious or rare diseases.
“AI doesn’t care how many questions you ask it, it can provide expertise and translate the medical jargon, and your time is not up after 15 or 20 minutes,” says Laura Adams, a senior adviser to the National Academy of Medicine and co-author of a recent report on the use of AI health tools.
Consumers don’t always find AI health information reliable, leading some healthcare providers to develop their own AI tools for their patient portals. And a report published in the New England Journal of Medicine’s NEJM AI in December warned of “an urgent need to assist patients with using these new technologies as safely and effectively as possible,” citing concerns about misinformation, lack of regulation, data-privacy risks, and insufficient research on the actual benefits and harms of patient use of AI.
However, Adams notes, “Patients are saying, ‘Look, if I have to wait six weeks to see a specialist to get answers about this, that is a safety risk for me as well’.”
Hugo Campos, who lives with an implanted cardiac device and has served on health-related federal advisory boards as a patient advocate, says he uses AI extensively to research health issues. He advises patients to formulate clear questions, provide all the relevant context about their conditions and request different possible diagnoses rather than a single answer.
“[AI] is not a one-and-done answer machine,” Campos says. “It’s a partner and a tool for helping advance your ability to comprehend things and think critically through a complex problem.”
Some patient advocates and medical experts predict AI chatbots will evolve into more sophisticated healthcare agents, coaching behaviour, organizing data and even working with clinicians to monitor patients.
AI is also being explored for use in online patient communities to help members better analyze their own data, find the right care and collaborate more effectively. “AI is going to be at the center of how the next generation of online communities work,” says Gilles Frydman, a digital-health expert and a founder of online patient communities Smart Patients and the Association of Cancer Online Resources.
The Wall Street Journal
To join the conversation, please log in. Don't have an account? Register
Join the conversation, you are commenting as Logout