I wouldn’t trust myself to correctly swab my throat, and I don’t have tonsils, so I have to have the back of my throat swabbed, which made me puke a little once, contaminating the swab, and causing the NP to have to start over (I warn them to stand to the side now).
But, I have a school-aged child. Sometimes when all three of us are sick (child, husband and me), the doctor will get a positive test from one of us, and give antibiotics all around, which may even be cheaper then three home tests.
I think the most salient point, though, is people using them every time they have the sniffles, and, along with incorrect swabbing, getting false positives.
With home pregnancy tests, false positives are pretty rare, because women who take them are usually experiencing some other symptom, and may also be deliberately trying to get pregnant. However, if you had a random cross-sample of people take them one month, including men, women who were not sexually active, and women who were infertile due to having tubes tied, you would get a much higher percentage of false positives.
Having doctors identify people actually at risk for strep, as opposed to anyone with a scratchy throat, or a cough and temp, take one, you get fewer false positives.
Today, not so much.
Contrary to what I have been told, I can go to the doc I trust, I just have to pay 100% of the costs … Ah, never mind, this crowd thinks all or even most doctors are really concerned about individuals instead of $$$
Some (and it varies some based on the product they use as well) would back up a negative rapid result with a 48 hour culture (especially if the clinical suspicion was high), but no one would back up a positive one.
It depends on the patient too. I am allergic to a lot of antibiotics. Right now, there is only one cheap one I can take that works well for strep, and the doctor does not like to use it much in case I should become allergic to it as well. If I have a rapid test+, my doctor gives me the antibiotic, or if I have very definitive symptoms, and my son or husband has a positive test, my doctor will give me drugs without testing me, because for some reason I catch it very easily, and it puts me on my back; I also used to get some of the paranoid and OCD/ADD symptoms as a child that had not yet been ID’d as a rare but definite pediatric syndrome that sometimes goes with a strep infection-- my doctor now hesitates to diagnose me with it after the fact, but she has seen my childhood doctor’s notes where he has pages of being puzzled over what he thought were repeated unusual reactions to antibiotics, or antibiotics plus codeine cough medicine.
Anyway, my point is, in my particular case, it’s important to get strep diagnoses right. If I’m the only one in the family with symptoms, and it really looks like strep, but the rapid comes back negative, my doctor always does a full culture, and then phones in an Rx for me if it’s positive.
I know what the poster who said strep feels a certain way meant. I almost always call it right when I have strep, but I have been wrong a couple of times, particularly when my son has had it first, and all I have so far is a tickling in my ears-- the full disease hasn’t set in.
It happens I also get bacterial sinus infections that don’t go away without antibiotics, though, so if that’s what I have, I need to know that as well, which is another good reason to go to the doctor.
Yeah, rapid tests are just that - rapid. The only time I really see cultures done are when the doctor thinks the strep may be antibiotic resistant, and orders a culture and sensitivity test to figure out what kills it, or if the clinical picture is just screaming strep and the rapid test is negative.
I personally think the rapid tests should be OTC. But not for prescription purposes. I’m just very into patient autonomy. I would very much like to take my own throat swab to help me decide if I should go to the doctor for a professionally done test, and then the treatment based on that. I suspect more strep goes undiagnosed and untreated because people don’t go to the doctor then would be ignored because of false negatives. That is, I think if we made a screening convenient and cheap, we’d see *more *strep appropriately diagnosed and treated by a doctor. And just like every cough syrup ever made, it should instruct people to contact their doctor if their pain persists, negative result or no.
When I thought I was pregnant, I took a home test that let me know I should go to the doctor. Who did a pregnancy test. She wasn’t going to suggest the treatment or schedule the delivery based on the fact that I told her my test was positive. When I think I have a UTI, I can get a dipstick test to take at home, and it lets me know if I should see the doctor, but he’s going to run his own test before he gives me a prescription for Bactrim.
I don’t see why a strep test would be any different. Except that it’s ucky to swab your own throat.
I don’t know anyone who’s ever gotten an x-ray who couldn’t have ordered that test on their own. In fact, I know at least two people who delayed getting one because they didn’t want to be arsed with going to the doctor first. But since prolonged x-ray exposure can be dangerous, a doctor should regulate that.
I honestly wouldn’t care if patients could order a CBC/PSA screening without a doc’s prescription once a year, if the patient believes it is indicated. Empower the patient and all that. As far as collecting the sample themselves, it’d depend on the difficulty. Obviously, peeing in a cup and swabbing your throat are on the easier end of the spectrum. Prostate sample? Not so much.
BTW, if you’ve ever had the misfortune of caring for someone who required long term care, you’d be amazed at what the medical profession entrusts us lay people with, with just a few minutes of training. Cleaning wounds, changing IV fluids, collecting urine samples, coordinating a multitude of prescriptions…it’s all in a day’s work for many non-medical caregivers.
While I think getting a good throat swab on an adult (let alone on a child or even moreso on yourself*) is harder than you may think (and harder than cleaning wounds or changing IV fluids which frankly are very straightforward things to do) the point is being missed.
You believe that x-rays (which are often way over ordered by even many trained healthcare professionals) can be appropriately ordered by the layperson but should be restricted because of the potential harm of the test. You however have a narrow and incomplete understanding of the harms of inappropriate testing.
“Empower the patient” is a nice motto but in real life actually it would, in many cases, mean significantly poorer care that could result in real harms. Healthcare is not a business in which the customer is always right. Blasphemy I know. As arrogant and obnoxious as this may sound, as much as I believe in educating my patients and helping to guide them through a variety of healthcare options, the patient does not always know what is best or when is best to test and when to give it a rest.
*I have personally done by now many many thousands of throat swabs, including on many scared children, and I do not believe I could swab myself adequately. Pee in a cup yeah. Swab myself? I don’t think so. Hell even swabbing my own kid was tougher than swabbing a patient.