DIY surgery (TDWI)

I was debating merits of do-it-yourself healthcare with my buddy, Brian Klepper, Ph.D—healthcare analyst and pundit extraordinaire—the other day. He is not a fan, preferring instead to have better, stronger, more informed, technologically enabled physicians working in accountable care organizations. I am also a big believer in ACOs, patient-centered medical homes, and informed physicians, and all that stuff, but I think increasingly healthcare consumers (a.k.a. patients) are going to want to control more of their healthcare than they are currently able to do today.


What’s available now

The internet has made medical information more accessible than ever before. People with serious illnesses and/or chronic diseases sometimes end up knowing more about their condition than their physicians. But reading and understanding a medical condition are only scratching the tip of the consumer empowerment iceberg. What I am really interested in exploring is how technology can be used to further drive a true “consumer-directed healthcare” revolution.

Now I want to make it clear I am not proposing that people do their own surgery (although some have done it). Nor am I proposing self-prescription of expensive and/or potentially toxic therapeutics. But I am talking about consumers being able to order their own lab tests without involving a physician…and self-prescription of certain categories of medications (e.g., statins).

Consumers are already doing some of these things. For example, diabetics routinely test their blood glucose at will. For years, women have been diagnosing their pregnancies via home pregnancy tests. Hand-held devices are available in most drug stores and online to measure hemoglobin A1c, cholesterol levels, test for a UTI, and even screen your urine for drugs before you go for your pre-employment drug testing. There is now an FDA approved test for HIV (you draw the blood at home and send it in to the lab).

Several companies on the market allow consumers to order a wide variety of blood tests, at a relatively modest price, and then go to a local affiliated lab for the blood draw—all of this without involving a physician. The tests come with interpretation. But if you want to learn more about your tests and what they mean, there is a website that can help you out.

Gadgets are also readily available for consumers to monitor blood pressure, heart rate, and fetal heart sounds. You can buy home defibrillators, portable interpretive EKG machines, and portable ultrasonic ultrasound devices for pain relief. You can stock up on stethoscopes, otoscopes, and ophthalmoscopes, and reflex hammers. Right now, for a price, your bathroom can be as well equipped as your average PCP’s exam room.


What the do-it-yourselfers are saying

Sure, you are saying, but who wants to do that? Well, the answer is some folks do want to do it. Here is a sampling of consumer comments from an online merchandiser that sells medical devices direct to consumer:

“Love the Otoscope! Very easy to use. My daughter has special needs and is prone to getting ear infections. since she cannot communicate, it is very hard to determine what is going on with her. No more guessing, can now look in her ears and can determine if she has an infection or not. No more waiting for 3-5 days for the doctors office to see her to check her ears.”

“Since my husband’s family has a history of heart disease, I thought I would look into getting one of these. In researching the topic at the Consumer Reports website, I found that they reported that the resuscitation rate nationally is 2 to 5%. With a Home Defibrillator, the rate jumps to 40 to 50%. In researching further, I found that the Philips is the only Home Defibrillator available to buy without a prescription. The website for this product,, has a wealth of information. They offer assistance in finding out if insurance or Medicare will cover some of the cost of this product…I was very impressed with the amount of on-line support at, including a video and a demo. The demo shows exactly how the product works. It removed all doubt about whether I would be able to use this product. (Obviously, taking the American Heart Association class is highly advisable!) Thanks, Philips.”

“Being a 1st-time mom and a diabetic, I fall into the ‘High-Risk’ category. I was constantly in an anxious state. I wanted peace of mind. After looking at dopplers all over the internet, I found most of the good ones to be astronomically priced. One day, I stumbled onto this site and read all the reviews. I figured I’d take a chance so I ordered my Angelsounds Doppler. As soon as I got it, I ran into my bedroom, slathered some oil on my tummy, and began the exploration. Within 3 minutes, I heard that distinctive ‘swoosh’ sound. I am nowhere near being a small girl. I was plus-sized before I was even pregnant. I’m only at 14 weeks so I was EXTREMELY impressed by the volume of the heartbeat and the ease in finding it. I HIGHLY recommend this doppler. I have been able to sleep soundly ever since I purchased it. You won’t regret this purchase!”

“I’ve already recorded, downloaded, and printed a few baseline EKG’s on myself and others, and I must say that I’m somewhat impressed with this unit. It seems to be the only one I’ve seen for the price that contains everything you need to get started right out of the box. The only thing you might need is more ekg pads if you intend to use the unit with the 3 wire plug connection. It comes with 3 EKG pads to get you started. I recommend this unit to anyone interested in learning about cardiac, small Doctors offices that want a quick snapshot of their patients, and to those that want to keep a record of their own heart condition for their Doctor to diagnose when visiting their office.”

As these technologies improve and become cheaper, I suspect you will see more consumers becoming fans of do-it-yourself healthcare. This is not to say that every consumer will want to be their own doctor. Nor is it to say this strategy is completely risk-free. Opponents will argue that self-diagnosis and monitoring could lead to misdiagnosis, delays in diagnosis, and a false sense of security. True, but getting these tests in a doctor’s office is no guarantee that you will get the right diagnosis at the right time every time. If DIY medicine does take off, you can be sure some entrepreneur somewhere will grow a business by providing low-cost, rapidly available advice, and counsel to support the do-it-yourselfers.

As consumers take charge, bypassing both traditional physician office visits and health insurance, it is just possible that a real market for these services can be established—driving costs down and quality up in a quest to provide value to the paying customer.


  1. I am a very well informed ‘patient’ and I consider the medical profession to be so heavily influenced by drug companies, starting in medical school, that I consider MDs useful only for those emergency situations–broken bones, traumatic injuries, severe pain, stroke, heart attack, very high fever in an adult, problems breathing, or actual bleeding that won’t stop.

    Even well-intentioned MDs have been indoctrinated into a ‘treat first–preferably with a drug’ mentality that makes them routinely prescribe drugs that do more harm than good and tell basically healthy people that they are actually ill (“pre-diabetic” “pre-hypertensive”, etc etc).

    I avoid MDs unless I am very sick, which is just about never.

    However, I know certain tests are useful indicators of my current health, and so I order blood tests online, look at the results, evaluate them myself, decide what non-pharmaceutical intervention (less fat, more walking) might be appropriate.

    The only thing I need a doctor to actually do on a routine basis is to check my prostate, but in the absence of symptoms or elevated PSA levels, I don’t actually worry about that much anymore, either.

    Most of us are much healthier than the medical establishment wants us to think we are: remember doctors and drug companies make money by on-going treatment of people who are (or have been convinced they are) ill.

    CURING people would put them all out of business.

  2. I agree with Dr Salber’s thoughts on DIY healthcare; however, I feel the future state will be something between Dr Salber and Dr Klepper’s approach. On the eve of healthcare reform and with the shortage of primary care providers, DIY healthcare and other patient-centered medical home approaches will continue to emerge and converge. If used in collaboration with a patient’s PCP,this emerging technology can fill in many of the gaps in care today and provide a much more collaborative approach to health care and reduce many unnecessary ER visits and readmissions. After all, doctors cannot be everywhere and watch their patients 24/7, so these tools are inevitable.Having spent over 25 years in healthcare and IT, my belief is that in the next few years we will see a major convergence between these diagnostic/medical devices, infrastructure companies (such as Cisco), integrated delivery systems/providers and care management companies. People we will be able shop around for alternative approaches to home care and plug in their medical devices (much like a TV today) and then communicate through secure, HIPAA compliant internet with their care team.Through these technology advances and new care delivery models that are emerging, consumers (in particular Medicare members/Baby Boomers) are going to be able to live more indepently and longer in their homes.


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