Florian-Klauer@Unsplash.com. // This is Addendum; series of additional sections for the parent manuscript Nutritional Humility™. These are intentionally kept separate from the parent manuscript to help maintain readability; without submitting north towards 500+ page count.

Ordering blood panel test is for some, an interrogation. I've not been able to give my thoughts on this for many years due to overlapping priorities in and outside of this concept initiative. I am only presenting these as alternative work-arounds and course of actions. By no means below may (or may not) guarantee their continued serviceship long after this article is published. 

Live-it-forward, AW™

(Copy & Paste; writing perspective switch to the manuscript's third person)

Panel tests sans GP referrals ~ your options.

To date, there appears to be only two (2) providers available as online ecommerce sites. I-screen (I-screen.com.au) and I-medical (imedical.com.au).

General checkups (metabolic, liver and/or kidney health) seems reasonably priced from both provider/s. However they are not exactly a 1:1 replica. Advanced lipids (APO differentiations) or detailed  thyroid panels for instance ~ may differ in terms of length and detail. To both preserve and respect intellectual property, this is NOT a guide presenting minute differences of the two in matrix chart/s or the like. Readers instead are encouraged to assess these parameters individually, by comparing their services parameters at their own end before all informed decisions.

For more comprehensive and detailed request/s, I-medical may be the more preferred route. Individuals are free to select any additional tests on top of existing pre-defined "panels"; specifically labelled as "A-Z" categories. These categories unfolds very specific testing opportunities. Specific enzymes. Steroid hormones, vitamin, and various lipid panels. That also includes options such as VLDL particle sizing determinations and analysis, which I-screen seemingly lacked. However, beware that these tests are very costly bordering towards at least AUD$150 (or more).

It is also noteworthy that many collection agencies, for some undisclosed reason ~ only resort to "higher-than / >" or "lower-then / <" symbolic reporting for the sake of simplified interpretation. For instance, kidney function (eGFR) may only be presented as ">90 ml/minute" as cut off reference range. Hence, unfortunately there is no knowing as to how high their actual readings are beyond "90". It could be 100 or vaguely interpreted as either "higher than 90" or to "infinity".

Having thus overseen the above disclaimers, six (6) overall food for thoughts are hereby presented.

As a general disclaimer, neither This Author (AW™) or This Book confides as legally abiding suggestions. By no means This Author's "opinion" are "final". Any services rendered by these third party provider(s) may change their terms, or operation of conducts at any stage in the unforeseen future.  

1/6

Which service provider is the more affordable? How "judgmental" are these providers?

This Author (AW) may only speak for from his own N=1 experiences. If cost is the outmost concern, I-screen is perhaps potentially the more affordable. They appear to be more frequently affiliated with intermittent discount offering. Groupon®, Cudo®, to name a few. Further, I-Screen appears to be well-designed, with both user-centric overall experience and branding delivered in mind.

Even though these providers casually use the terms "non-judgmental", "Confidential" and/or "private" ~ please note that all results will still have to be screened by "APHRA" accredited practitioner/s.

In the case for I-Screen, individuals are provided with a questionnaire panel on which these are used for the practitioner to "recommend next steps" or for "for more comprehensive feedback".

However, their privacy policy looks somewhat elusive. "You are not obliged to provide personal information. However, failure to do so may result in us, and other users of our Website, being unable to provide you with Services or certain content.". Whether or not they willingly conduct their "Services" with limited "personal information" (be it medical history, basic stats ~ age, sex, height and weight) provided may yet lead to an overall incomplete medical enquiring.

This unfortunately proves concerning. Especially for those wishing outmost unbiased, free-of-judgment medical enquiry. I-Medical on the other hand, does not seemingly impose the above clause.

Suffice to say, I-Medical provides only very brief email messaging with pathology request forms immediately downloadable. Once results are shared - little to no indicative sentiments on the letterhead as provided. This is generally the norm of received communications. Unless of course if the results needed much warranted, or obvious ~ attention.

Nevertheless, both providers are excellent in both serviceship and customer courtesy.

2/6

What / which Pathology panel agencies are "accepted"?

At the time of this writing (May 2020) I-Screen accepts a total of four(4) Pathology collector agencies (NOTE: these may yet be state-specific):

1. Dorevitch
2. QML and TML
3. Western Diagnostic
4. Laverty and;
5. Abbott

I-medical on the other hand accepts the following agencies, which vary from state to state as openly stated on their page:

1. Australian Clinical Labs (NSW,VIC, SA, WA & NT)
2. Medlab (State/s Unspecified)
3. Western Diagnostic (State/s Unspecified)
4. QML (QLD, North NSW)
5. Laverty (NSW, ACT)
6. TML (Tasmania)

3/6

How long does it take for results to arrive?

This Author (AW™) finds this question impossible to answer. Since both collection, and interpretation procedures vary widely inbetween collector agencies. However it is generally safe to assume that the more elaborate, "advanced", or "detailed" the panels requested ~ the longer time needed for reporting and interpretation.

The "fastest" response This Author witnessed (by either I-Screen or I-Medical) was one (1) full day turn around for a result to be submitted. Unexpectedly; reporting turn-around feedback, may also falls on a weekend. Although this experience is noted only with I-Medical. 

I-Screen (owing once again to User-centric experience) despite more delayed in turn around response ~ nonetheless provide a better all around UX (user experience).

Try not to be surprised if you feel confronted. At least, you'd know the reason why behind a spike in blood pressure. 

4/6

What else should I be aware of when ordering these tests?

It is essential to provide two (2) printed evidences on hand, on the day of collection:

1. The original referral form.
2. Print / evidence of email receipt of purchase of panel.

The reason for presenting the above is for readers to (brace upon) verbal explanation with the collection nurse for clarity. Many are unfamiliar with these private panel service providers. Common questions will arise, such as:

1. "Why do you not see your doctor first?"
2. "Who will be paying for this?"
3. "Have you paid for this? If so, what receipt or evidence do you have?"
4. "Who are these private providers? What credentials do they have?"

This Author (AW™) nonetheless provides the following series of responses, for readers to consider re-adapting:

1. "As law-abiding citizen under free speech, it is my right to seek alternative services that does not require additional prejudice impositions. My own health is my own legal right to exercise my privacy and thus curiosity to self-enquire; again without fear of prejudice".
   
2. "It is becoming clear that healthcare costs are rising. This includes the need for GP pathology referral/s. In addition, they at times refuse even the most conventional requests. Consequently ~ frowning patients with authoritarian condescends. Therefore, I retain the right to pursue alternative panel providers bypassing such barriers; to allow my own health self-enquiry. Without fear of prejudice."
   
3. "The panel provider is the firm that I have paid all my financial dues for such a private test request."
   
4. "Yes, I have evidence of payment made in full. Please see the receipt." <present printed evidence of payment / email confirmation>. "Please also witness the DOCTOR CODES and BILLING CODES on the referral form" <point and highlight by hand>.
   
5. "These private providers are run by various pathologists with clearances to NATA accredited laboratories." "I am happy for you to verbally confirm these with your supervisors. Please once again witness the DOCTOR CODES and/or BILLING CODES as clearly shown on the referral form here and here." <point and highlight by hand>.

5/6

I have witnessed that panel collectors are fussy when it comes to length and duration of fasting. Is this true?

It appears that depending on the nurse / personnel on duty ~ some may downright refuse collections whose patients have undergone longer than 12 hours of fasting. Conventional parameters generally discourages anywhere beyond 12 hours of fasting.

When lightly questioned with "why" ~ the best response This Author (AW™) from memory is as seemingly condescending (or laughable, depending on which angle) ~ "because you would likely been out of blood sugar by then". 

Unfortunately, the very best workaround to this is to simply be honest, frank and upfront with them. This however, requires readers to also prepare for clarified elaboration on why the need for extended fasting duration. Hence, assure them that it is all in the interest of food / general health and lifestyle affirmations for conscious and mindful consumption.

Generally, (they) will soon agree. And should soon submit to your request.

If refusal still remains persistent, politely thank them nevertheless and immediately phone / call another pathology collection elsewhere nearby.

Grafierende @ unsplash

(BONUS Q)

What happens during COVID-19 pandemic?

As if high living costs is not dire enough ~ recent tensions on COVID non doubt compounded further difficulties.

As of this addendum writing amidst overlapping obligations (May-July 2020), many collection agencies refuse to take walk-in visitations. Some only accepts COVID-19 priority testing. Some have permanently closed (without prior notice). Some may even refuse conventional panels altogether.

At the very least many agencies have responsibly plastered bold notices / posters in front of their premises at notifying any changes for collection procedures. This Author (AW™) particularly noted from experience ~ that Western Diagnostics are amongst the most affected by these changes and thus ~ likely presents the most challenges to conventional panel requests.

Readers would be thus wise to firstly enquire direct with the pathology branch nearest to them. See how these arrangements may differ during these pandemic management.

To summise

For those who can (regularly) afford, blood tests are an insightful luxury. Given the costly healthcare receptions both nation (and world)-wide, it becomes more imperative for individuals than ever to take initiatives for scientific self-enquiry as far away from medical prejudice and paternalism.

I-Screen may favour those who still wish the general comfort of user experience and branding, also with budget-consciousness in mind. For as long as they are comfortable risking to surrendering more medical history information. I-Medical on the other hand is more industrial, straight-to-the-point request. I-Medical also potentially provide more highly specific & robust A-Z choice of testing. However beware that these prompt much more costly requirements.

The choice now remains open to all readers.

As a prominent disclaimer, This Author (AW™) is not and never, in anyway shape or form – affiliated with the above service provider(s) nor the collection agencies. This Addendum serves only as pragmatic food for thoughts for hopeful assistance towards clarified decision making.

For more information please visit and directly contact the private providers website as provided (I-screen.com.au and Imedical.com.au).