Doctor's orders? Not always necessary

Many medical tests can now be requested by the consumer from laboratories and through the Internet

Health & Fitness

October 06, 2002|By Benedict Carey | Benedict Carey,Special to the Sun

Getting a "simple" blood test can seem about as simple as getting a mortgage approved. There's the 20-minute schlep (minimum) to the doctor's office and back; the long purgatory of the waiting room; then the hour or so shuttling among doctors, nurses and medical technicians, only to learn -- after half the day is blown -- that the results won't be ready for a week or more, sometimes requiring another appointment.

To which many Americans now say: Forget it. Commercial testing labs and Internet brokers have begun to bypass doctors, selling medical tests straight to consumers. So-called direct-access testing has its appeal: Roll up a sleeve, slap down a credit card or cash, and choose from a menu of 30 to 50 tests. The results are often available the next day, on the Web; no doctor's order is required, and no insurer is involved.

"Time and convenience are quality-of-life issues for me," said Jeannette Leach, 49, a scientist in Boulder, Colo., who has ordered tests to help monitor her thyroid condition. "The lab I visit is lo- cated on one of the roads I use to drive to work. It opens at 8 a.m., and at 8:01 I'm there, and 10 minutes later I'm on my way to work."

"The number of people doing this right now is very small, we think," said Dr. Bruce Friedman, a professor of pathology at the University of Michigan School of Medicine, "but it should have enormous appeal to the sort of health-conscious consumers who are most enthusiastic about exercising control over their own health care."

Limited health assessments, such as stroke screenings and blood-pressure checks, are increasingly offered at pharmacies and grocery stores, and full-body X-ray scans have proved so popular that they're now at some malls. The world's largest diagnostic lab, Quest Diagnostics Inc., opened direct-testing locations in Colorado, Kansas, Missouri, Maryland and Virginia and has partnered with Giant Food, the grocery chain, to sell a range of blood and other tests in stores.

So far, direct testing appears to be growing most on the Internet. Demand has not been strong at walk-in outlets, said Jondavid Klipp, managing editor of Laboratory Industry Report, who has surveyed some of the labs. Quest would not disclose the number of tests it has done. Yet Web-based outfits have seen increased sales in the first half of this year. Online outfits contract with local labs to collect blood or other samples, then have the fluids shipped out of state for testing.

Although many states have laws prohibiting labs from performing most tests without a doctor's authorization, direct-to-consumer Web sites aren't subject to such laws if their labs are outside those states.

According to Friedman, who has studied the emergence of the e-laboratory, direct testing has two principal attractions: easy access and privacy. Health-conscious people who want tests more frequently than their doctors order are one category of users. So are people who want to check their blood and urine before submitting to a drug test. The list also includes people who want to test themselves for HIV or hepatitis C anonymously, or who want to peek at certain values -- such as cholesterol levels -- in private, before shopping for health insurance or changing plans.

The most popular tests are standard blood panels, which include anywhere from 12 to 20 different measures, from cholesterol and glucose levels to markers of liver and kidney function. These panels are often ordered as part of routine physical exams, but the demand for them suggests another category of user: affluent and busy people who want to see their test scores without going to visit a physician.

As a rule, direct-access testing labs strongly advise their customers to consult with a doctor. "We have been very clear that this testing is no substitute for seeing a doctor," said Hughes Bakewell, vice president of consumer health at Quest. "We see our service as a complement to regular doctor visits."

Yet there's no guarantee that most direct-access customers will consult a professional. "Here we have a situation where people may be getting false assurances about their health and not making follow-up appointments when they should be, or becoming very anxious about a test result when there's no need to be," said Dr. Linda Rosenstock, dean of the University of California, Los Angeles, School of Public Health.

Many researchers agree that some people with certain conditions could benefit from quick, convenient testing. At the same time, anyone who has blood tested regularly is bound to get a few abnormal results -- some mistakes and some not. That's when it's crucial to check with a physician.

"The doctor is the one person who can take all this information and actually tell you not only what it means, but what to do about it -- or not do," said Dr. Anna R. Graham, president of the American Society of Clinical Pathology.

Benedict Carey is a reporter for the Los Angeles Times, a Tribune Publishing newspaper.

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