The New Trend in Healthcare: Do-It-Yourself; With doctors under strain in the pandemic, patients are taking more of their healthcare into their own hands
Morris, Betsy.Wall Street Journal (Online); 11 Jan 2022.
Two years into a pandemic that has strained health systems and made booking doctors' appointments next-to-impossible for some, patients are providing more of their own care at home.
Elizabeth Ditty says she struggled to get a doctor to pay attention when she felt lethargic and unable to lose weight. So a year ago she ordered do-it-yourself kits for medical tests to measure hormone and cholesterol levels and detect food sensitivities. Based on the results, the 39-year-old screenwriter in Kansas City, Mo., adjusted her diet, adding supplements and eliminating eggs. She says she feels better and has lost weight.
"I took matters into my own hands," she says.
Ms. Ditty is part of a do-it-yourself healthcare movement that has accelerated during the pandemic, doctors and industry analysts say. Frustrated with an overburdened health system, more consumers are turning to gadgets, home kits, apps and monitors for tasks and tests previously handled by trained medical workers. They are monitoring their own blood pressure, conducting EKGs, tracking blood sugar and cholesterol levels, and pricking their own fingers for blood tests normally done at the doctor's.
Many doctors support patients taking more responsibility for their own care, but warn that too much DIY without expert guidance could miss important health problems. Despite those concerns, more physicians are recommending that patients shoulder at least some additional work, because staff shortages and worker burnout mean that patients often face long wait times for appointments and overloaded care providers.
"I tell my patients, 'You are your first line of defense. The system can't take care of you,'" says Wendy Wright, a nurse practitioner who owns Wright & Associates Family Healthcare, two clinics in southern New Hampshire. Her wait list has grown to more than 100 people. "We can diagnose and treat you. But it might not be in a timely manner," she adds.
Dr. Wright, who has a DNP or doctor of nursing practice, now asks patients to monitor blood pressure with devices they can buy at the pharmacy or on Amazon. She asks them to send her the electrocardiograms from their smartwatches and reviews the data at the end of each day. The real-time data reduces the need for in-office appointments and speeds up her diagnoses and referrals to specialists.
For her migraine patients, she recommends apps like Migraine Buddy that help patients share with Dr. Wright data such as headache frequency and duration, along with food consumed or weather changes.
Previously, migraine patients would have their medications reviewed or adjusted every two to three months in in-person appointments. Now Dr. Wright can adjust medications in two to four weeks. Patients input the data into their apps and she can review the data and make changes to their medication via a patient portal, without having to get on a phone call.
Another home test some doctors are recommending more often: A first-line screening for colon cancer that can reduce the need for a colonoscopy. Some of the tests allow users to collect their own stool sample at home then ship it to a lab for analysis. Unlike a colonoscopy, they don't require fasting for hours before the procedure, taking time off work to visit the doctor or undergoing sedation. The test still requires a doctor's prescription and is recommended only for people at average risk of colon cancer; certain results may warrant a follow-up traditional colonoscopy.
Whether the colon-cancer screenings and other home tests, apps and devices are covered by insurance depends on the specific product and on an individual's insurance coverage.
Self-testing and monitoring have downsides, and many doctors are wary. Smartwatches, rings and other digital devices that measure, say, heart activity and sleep cycles, can be helpful but aren't always accurate, doctors say. Neither are all diagnostic tests.
"I would caution against patients trying to interpret their own labs [lab results]," says Carl Andersen, medical director of executive health at Mayo Clinic in Rochester, Minn. Patients often see minor variances in the results and assume they're doomed, he says, or they see results they think are normal "when actually in the context of their own health profile it's more concerning."
Patchwork testing and self-directed care can miss larger problems, says Natasha Bhuyan, a family physician and West Coast regional medical director for One Medical, a provider of digital and in-person primary care. She recalled a new patient who came to her a few years ago with a sore throat that wouldn't go away after consultation with a virtual doctor and antibiotics from an urgent-care clinic. It turned out that he had HIV, which she ordered testing for after taking his personal history.
Patients should take some greater role in their own care, says Shantanu Nundy, chief medical officer of digital healthcare firm Accolade Inc., which owns PlushCare, a virtual primary and mental-health care provider.
"Healthcare is complex," he says. "But so is buying a car or a computer. Patients are smart." Pandemic scrambles for vaccine appointments and Covid-19 tests have given people practice finding their own care.
Dr. Nundy points his patients to apps he thinks would be helpful—for weight loss, meditation and getting a prescription refill without having to make office appointments. He wants them to know when they are due for routine tests, such as mammograms and colon-cancer screenings, without having to depend on doctors to tell them. He coaches patients on where to go online to find the best price on prescriptions or order do-it-yourself lab tests.
One of those places is Austin, Tex.-based Everlywell, a pioneer in at-home health testing founded in 2015 by Julia Cheek, now chief executive of parent company Everly Health Inc.
Everlywell now sells more than 30 tests for a range of conditions including Lyme disease ($109), fertility ($149), thyroid function ($99) and vitamin D levels, HIV and cholesterol each at $49 apiece. Ms. Cheek says orders for many of the test kits more than doubled in 2021 compared with the prior year; orders for the women's health-test category, which includes fertility, perimenopause and postmenopause testing, more than tripled.
"What the pandemic did was show that hey, this is a model that actually works," she says.
