A few days ago, as I was walking towards the hospital, one of the security guards of my residential complex greeted me politely. I sensed he wanted to discuss something with me. Formal medical consultation is quite expensive for workers in lower-wage brackets and over time, I have grown cognisant of their reticence in seeking informal consultations. So, I reverted his greetings by asking whether all is well with him and his family. He said some blood test reports had created panic in his family.The brief conversation that followed and a quick glance of the test reports were eye-openers for me to realise the widely spreading social phenomenon of self-prescribed lab-testing and self-diagnosis among the financially underprivileged. The poor security guard had spent a huge amount on blood tests which was neither necessary nor appropriate for him. To my surprise, all these tests were suggested to him by his relatives, none of whom had medical backgrounds. In an era where services of labs and diagnostic centres, especially by private laboratories and online platforms, are available in urban centres, people – many with the inability to afford doctor’s visits – are inclined to avoid the formal route of consulting qualified medical practitioners and then going for lab-tests as prescribed by them. Of late, with the active involvement of the private sector, accessibility of laboratory test facilities has increased considerably in urban areas. This open-arms accessibility, supported with attractive marketing strategies and web/platform possibilities, has opened new doors for the public who are no longer in the habit of delaying their diagnosis due to inaccessibility of lab-facilities. Facilities like home-sample collection and digital reports have made accessing healthcare smoother and more convenient, which is especially true for the elderly. The overall hype created over the need for regular lab-tests and the resultant increased health-awareness encourage people to be more proactive about their health. Beyond doubt, increased availability and use of laboratory packages help in early detection of many chronic diseases (like diabetes, anaemia, thyroid disorders, and early-stage cancers), which in turn promotes preventive care. As most of these chronic ailments take years to become pathological, an early detection not only prevents biological damage but also provides scope for complete reversal of the disease. Notwithstanding this merit, there are also many flip-sides for this contemporary flood of lab-testing facilities in urban areas.Blindly following standardised lab packages imply erosion of clinical judgement. ‘One size fits all’ is always a bad idea and it becomes worse when it comes to human biology. No two individuals are the same and their differences go on increasing with age. That is why we often see some senior citizens running marathons without any ailment, while many others in their age are suffering from multiple chronic diseases. Only a trained medical practitioner will be able to aptly prescribe who needs which investigations – that too after a comprehensive physical assessment and history tracking which involves a process of asking patients their family history, addiction history, psychological and medication history and so on. Self-selected medical investigations by patients will only be useful to gather a bunch of irrelevant information without any clinical significance, thereby adding excessive panic and anxiety. As these tests are done bypassing proper professional clinical evaluation, it will also prompt unnecessary follow-ups, often with more severe financial implications.Self-referral also implies a fragmentation of the healthcare ecosystem, as it disconnects diagnosis from trained physicians’ involvement, thereby leading to a lack of coordination in patient care. It will also increase the likelihood of more and more people trying to treat reports with over-the-counter medications or trying to copy the treatments of some of their dear and near ones with similar lab reports. The end result of both these practices is the increased risk of deterioration of health.Increased commercialisation of medical businesses, with widespread practising of unethical and pernicious practices is yet another concern. Labs often bundle tests for profit, rather than based on medical necessity. I have seen many patients panicking about their HsCRP reports in which there is a note on their increased chances of heart attack. In reality, HsCRP can rise as a result of multiple acute or chronic inflammatory conditions and is not always suggestive of heart risk. There are also hidden possibilities of data misuse and privacy risks, where the patient’s health particulars are misused or sold, with potential implications for insurance or employment.Self-initiated tests also add to the workload of doctors. Even after counselling patients on the fact that these slightly deviated values are not very relevant and can be completely normalised with lifestyle modifications, many doubt the clinical judgement and capability of those doctors who contradict lab reports. Such erosion of trust over doctors leads to situations where patients seek multiple consultations with different doctors just for their psychological satisfaction, thereby wasting lots of money and time running behind these irrelevant findings. All these impacts the healthcare system as it diverts resources to manage incidental findings instead of managing patients in need of care. Essentially, all these cumulatively intensifies health inequity at a macro level, as over-testing in urban centres coexists with under-diagnoses in rural areas.Amidst cut-throat competition in the lab-markets, labs are offering their packages cheaper, mostly by compromising on the quality of test results. Thus, it is high time that focused attention of authorities be given on governance and ethical issues, with special emphasis on monitoring quality and regulating marketing practices of test packages.I am not making a case for banning tests or discouraging cheaper diagnostic packages. Rather, my intention is to argue for adopting guideline-driven testing panels, with utmost importance attached to the role of physicians in recommending and interpreting tests. We need to graduate to a system where even for preventive health check-ups, one can visit a doctor first and then proceed only to get those tests done which are professionally advised. Thus, the need of the hour is creating public awareness on the risks of unnecessary tests, backed by a strong regulatory mechanism to check profit-motivated, pernicious and unethical practices in the sector.Dr Harjit Singh Bhatti is an MD in geriatric medicine from AIIMS, New Delhi, and is currently a consultant at the Sitaram Bhartia Institute of Science and Research, New Delhi.