Online Symptom Checkers and DIY Lab Tests: Pros and Cons

Visits with your doctor and to a laboratory test site at least once annually, and often more frequently, are routine health maintenance events for older adults who want to be proactive about their health and well-being.

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Typically, however, doctor office and lab visits are time-consuming, three-day affairs. On day one, after driving, parking and then waiting for 30 minutes or longer, “the doctor will see you now.” On day two, after another drive, park and wait (and usually under a 12-hour fast), a doctor-prescribed blood and/or urine lab test must be taken. Depending on the lab results, day three entails the likely possibility of a return visit to the doctor’s office for a review of test results that may indicate an important need for changes to  your overall health care maintenance plan.

Is all this traveling, parking and waiting necessary? Plus, for patients with high deductibles or no Medicare supplemental insurance, such three-day affairs can be costly, making some wonder if there's a better way.

To save time as well as to enhance communication with their doctors, patients are increasingly taking matters into their own hands, using online symptom checkers to get a better idea of what may be affecting their health and do-it-yourself (DIY) at-home lab tests bought online or at a local pharmacy without a prescription.

In this scenario, a trip to a lab waiting room could become unnecessary. Plus, some patients may be able to engage in a remote eVisit or phone call with their doctor to discuss what they discovered, making the entire process one in which they never leave their homes. It’s doable today, but there are a number of caveats to consider.

Most important, older adults must clearly understand how to effectively take advantage of online symptom checkers and be cautious about DIY at-home lab testing services.

While online symptom checkers can be effective for getting a keener understanding of a wide variety of personal health concerns, they should not be considered definitive self-diagnostic tools.

WebMD chief medical director Michael Smith explains that online symptom checkers are not meant for making any final decision about what’s ailing you.

“There is much more involved,” he says. “Tools like the WebMD symptom checker can help you determine if there is something that might need more urgent attention. They are meant to help guide and direct people down the right path, but that path ultimately lands with their doctor.”

Sandhya Pruthi, chief medical editor for Mayo Clinic, refers to the Clinic’s symptom checker as a tool to educate patients and “definitely not to diagnose.”

Patients also need to feel confident that any online symptom checker website is a source of reliable information. This can be done by scrolling down to the bottom of a symptom checker’s home page to see if the site is HONcode certified and/or URAC-accredited.

Of the two, URAC is the more stringent standard for ensuring that a medical-oriented site’s information is credible. “URAC is an accreditation [conducted every two years] that very few health websites have,” Smith says. “It’s a lot of work to put all of our content through their process to make sure that we stand up to the criteria to be URAC accredited.”

After using an online symptom checker, patients often take their self-examination a step further by ordering a DIY at-home lab test to possibly obtain a clearer idea about whether they have a serious health problem. For example, a patient’s symptom-checker results could suggest that the person may have type 2 diabetes, high cholesterol or a thyroid condition that a DIY at-home lab test could identify more specifically without having to first deal with a face-to-face doctor visit.

The Food and Drug Administration (FDA) refers to DIY at-home lab tests as “Direct-to-Consumer” (DTC) tests. There are plenty of easy-to-access, ecommerce-oriented websites selling DIY at-home lab tests, but many of these tests lack important information showing whether they are valid and authoritative.

Many DIY at-home lab tests are overnight-delivered with “kits,” where you submit a blood, urine or saliva sample that gets shipped to a lab for analysis, with results sent to your email inbox or via snail mail in a few days. Other pharmacy-bought DIY at-home tests provide immediate results, such as urinary tract infection tests that include detection strips, or digital glucometers, with strips, that measure blood-sugar.

According to the FDA, while DTC tests “can lead to consumers becoming more engaged in their overall health and lifestyle decisions, results from DTC tests should not be the sole basis of any type of medical condition decision-making, as these tests provide only one layer of a bigger picture.”

If a home lab test provider does not list a lab it partners with for test analysis results, consumers can request that information from the provider and go to the CMS/CLIA website where additional details about a particular laboratory can be obtained by contacting the appropriate State Agency or Regional CLIA Office.

Depending on the test, prices can vary, ranging from $20 to $49 for an at-home Hemoglobin A1c test (measuring long-term glucose levels) or a total cholesterol test kit to tests that measure levels of Vitamin D, costing from $50 to $80; to a variety of tests that screen for thyroid diseases and conditions, ranging from $40 to more than $300.

For comprehensive information about at-home lab testing, the nonprofit American Association for Clinical Chemistry (AACC) publishes a patient’s resources section on its website Lab Tests Online. Patients can check out the site’s alphabetically listed Tests Index section for detailed information about any test they might be considering.

More than the actual tests and devices used, however, the laboratory that analyzes at-home test results is most important. According to the site, “AACC recommends that only CLIA [Clinical Laboratory Improvement Amendments] laboratories perform DTC testing and that such facilities provide consumers sufficient information and/or access to expert help to assist them in ordering and interpreting tests.”

According to the FDA, “the CLIA regulate laboratory testing and require clinical laboratories to be certificated by their state as well as the Center for Medicare and Medicaid Services (CMS) before they can accept human samples for diagnostic testing. Laboratories can obtain multiple types of CLIA certificates, based on the kinds of diagnostic tests they conduct.”

AACC president Dennis Dietzen strongly advises consumers to do their homework before using any at-home test, especially if it is a unique test that is not typically available anywhere else.

“If there is a test out there that somebody is touting for some reason, and you don’t find that test at Lab Tests Online, that should immediately raise some skepticism as to the value of that particular test,” he says.

Dietzen adds that he has discovered at-home food allergy tests sold online, for example, that are "completely bogus," with “no basic biological evidence that you could detect food allergies using their system.”

Despite all the warnings, advice and fact-checking consumers need to consider when using online symptom checkers and DIY at-home lab tests, they can be viable alternatives to the three-day scenario. However, most primary care doctors are not quite fully on board yet.

For one, at-home test results are not compatible with doctor office electronic records filing systems, so your test results won’t be recorded for your doctor to view at your next routine physical, for example. That means the coordination of your care could be jeopardized.

Nonetheless, Dr. Joseph Kvedar, vice president Connected Health at Boston-based PartnersHealthCare and author of The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan, is very much in favor of patients who utilize such DIY applications.

“Anything that enables a patient to take more charge of their own future and engage in their health care is generally a good thing,” Kvedar says. “I’m sure if you have a relationship with your doctor where you can have an intellectual discussion, you can bring in your results and say things such as, ‘I’d like to do it this way. Are you comfortable with that? Is there a reason why I can’t? Tell me why I can’t. Why do I have to go to your lab? Why can’t I do it this way, since it is more convenient for me?’”