NPR: Pros, cons of genetic testing in the primary care setting

Genetic tests are making  their way into primary care settings  — for example, Danville, Pa.-based Geisinger will offer DNA sequencing to 1,000 patients in June and Sioux Falls, S.D.-based Sanford Health plans to include genetic screening for diseases and drug-gene interactions mid-year — but some experts have questioned the necessity of these services in routine care, according to NPR.

Analyzing a patient's DNA may not be within the scope of a primary care physician, and moreover, genetic information may not be necessary to provide quality  care in the primary setting.

A professor at Lebanon, N.H.-based  Dartmouth Institute for Health Policy and Clinical Practice, H. Gilbert Welch, MD, expressed concerns of overtreatment as a result of routine DNA sequencing.

"Doctors will feel the pressure to do something — start a medication, order a test, make a referral," he told NPR. "You have to be careful. Bad things happen."

Other clinicians aren't sure how feasible it is to integrate genomics into such short appointments. A recent survey published in Health Affairs echoed some of these concerns. The survey of clinicians found just 25 percent respondents said they felt prepared to work with patients who had genetic testing done to evaluate common diseases or genetic conditions.

"Our plates are already overflowing, and now you're going to dump a lot more on our plate," the study's co-author and an internist at New York City-based Mount Sinai Health System, Carol Horowitz, MD, told NPR.

Geisinger, however, is confident about its new offering. The trend-setting health system will only communicate actionable mutations to patients, and physicians will take a 30-minute online continuing education tutorial to review genetic testing and learn more about each patients' unique results. Then, the patient will meet with both their primary care physician and a genetic counselor, if they chose, to discuss any treatment or prevention options.

"Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan," a Geisinger spokesperson told NPR. "We are preventing disease from happening."

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