> One easy way: you can telehealth for say $50 and do a rapid strep test which is like a covid test and does not require a lab to process it.
The sensitivity of rapid strep tests is already low (and the cost/risk of untreated strep quite high), to the point where standard-of-care already dictates that negative rapid results be followed up with a lab culture. Not everyone follows that in all circumstances, but it is considered standard of care.
The real-world accuracy of OTC rapid strep tests performed at home by untrained non-clinicians is even lower.
There are cases in which a strep diagnosis is warranted without all of the above, but the picture you're painting is overly optimistic in terms of cost, and measurably degrades quality of care for patients compared to the status quo.
98% is the specificity in the link you cited, not the sensitivity, which would be the relevant statistic. That's also a consumer-facing marketing page for an urgent care clinic that just cites "sources", so you should probably take anything you read there with a grain of salt. It's essentially an advertisement.
But furthermore, we're not talking about the tests performed in a clinic by a clinician. We're talking about OTC tests performed at home by an untrained non-clinician.
> Ok so 90% sensitivity.. Anyway, it seems backup culture is rare and also problematic.
This is the danger of Googling around for information without any contextual domain knowledge.
- You're quoting a statistic from an op-ed (op-eds are not fact-checked, let alone peer-reviewed)
- You're misquoting the statistic as provided by the op-ed (that op-ed is written about a test with 95% specificity, as claimed by the author)
- You're quoting an op-ed written by a witness called to testify in the defense of a physician who was sued for not following the documented standard-of-care - hardly an impartial source
- You're quoting an op-ed written about a single case (n=1). Furthermore, it is chosen not even as a medical case study but rather because the legal case is of financial interest to the author
- The op-ed is nearly fifteen years old - and, as it turns out, the prevalence and risk of rheumatic fever is radically different in 2023 than it was in 2008, for the worse.
- Even if you discount all of the above, the op-ed as taken at face value is written about a case in which a patient didn't get a backup culture drawn and ended up requiring two heart valve replacements (!) after a false negative on the rapid strep test. Regardless of whether or not the doctor is legally liable, it's not a good argument that rapid tests are sufficient.
If you go about looking for information to support your argument, it's often likely that you'll be able to find something that on the surface seems to support your case. But if you don't have the necessary domain knowledge to evaluate the trustworthiness of the source, the accuracy of the claim, or even its relevance to the matter at hand, that can lead you astray.
The sensitivity of rapid strep tests is already low (and the cost/risk of untreated strep quite high), to the point where standard-of-care already dictates that negative rapid results be followed up with a lab culture. Not everyone follows that in all circumstances, but it is considered standard of care.
The real-world accuracy of OTC rapid strep tests performed at home by untrained non-clinicians is even lower.
There are cases in which a strep diagnosis is warranted without all of the above, but the picture you're painting is overly optimistic in terms of cost, and measurably degrades quality of care for patients compared to the status quo.