Doctors don't like it when patients can do without them

[Guest guest]

Doctors don't like it when patients can do without them

 

http://www.reason.com/rb/rb040302.shtml

 

" Soy vampiro, " laughed the lab technician in the storefront

laboratorio that I went to more than 10 years ago when I worked in

Costa Rica. I had gone to one of the scores of laboratorios that were

located throughout downtown San Jose for a blood test to see if I'd

been infected by some parasite or other. The test was fast and cheap

and I remember thinking, " What a great idea. Why don't we have these

in the United States? "

 

Well, the good news is that we do finally have some retail medical

labs catering directly to consumers in the U.S. The bad news is that

many physicians are opposed to them.

 

Today, lab testing companies like Quest Diagnostics and Healthcheck

USA and wellness groups like the Life Extension Foundation are

offering a variety of tests directly to consumers at storefront

testing labs and over the Internet. In the Washington, D.C., area,

for example, Quest Diagnostics has partnered with US Wellness centers

located in Giant Foods Pharmacies where consumers can get a blood

test for cholesterol or diabetes or many other health concerns while

they pick up a loaf of bread and a gallon of milk. What could be

simpler?

 

The range of tests offered is comprehensive. Consumers can test their

cholesterol levels, thyroid and liver function, diabetes risk, and

prostate cancer markers. (They can also test for various infectious

diseases.) Consumers use the information to decide whether or not to

see their physicians. The test results are supplied confidentially to

consumers -- Healthcheck USA, for example, supplies lab results via

the Internet using 128-bit encryption.

 

Physicians object to offering tests directly to consumers on the

grounds that they are difficult to interpret and that false negatives

may mislead patients into thinking that they are healthy. " Trying to

interpret lab tests is a very complex and very specialized thing that

requires knowledge far beyond the usual layperson's ability, " said

Dr. J. Edward Hill, chairman-elect of the American Medical

Association in The New York Times. " It's unfathomable that people are

going to order tests that take years of medical training to

understand. "

 

But how hard is it really to interpret such tests? Typically labs

return results in a form that alerts clients if any of them are

outside the normal ranges. " Reading lab tests is not that hard. It's

not difficult to see if something is out of line, " says George

Vaughan, CEO of Healthcheck USA. In cases where the tests indicate

that something may be really wrong, many labs will call clients

directly urging them to see their doctors immediately.

 

The AMA's claim that test results are too complex for laypeople is

also simply outdated. There is an enormous amount of good medical

information on the Internet that can provide background for people

with health concerns and help them understand their lab results. But

clients must keep firmly in mind that the retail testing labs do not

offer diagnoses. If a test is anomalous, all the labs advise clients

to visit their physicians immediately.

 

But what about false positives (a test that suggests a person has a

problem when he or she doesn't) or false negatives (a test that

indicates a person is healthy when he or she is not)? " Any lab,

including any that a doctor refers his patients to, can have false

positives and negatives, " says Vaughan. " That's a risk that is just

an inherent part of all medical testing. "

 

A more troubling reason for the AMA's opposition to retail testing

labs is a desire to make sure that licensed medicos get a piece of

the action. Doctors have traditionally served as testing gatekeepers.

In order to get a test, a patient would first have to see a doctor --

who of course charges for the visit. Good for the doctor, not

necessarily good for the patient. With doctors acting as testing

gatekeepers, doctors may feel constrained to recommend only tests

that are covered by a patient's health insurance. Retail lab testing

allows clients to take immediate advantage of the scores of new tests

that are emerging from biotech research companies, instead of waiting

for insurance companies to agree to cover them. Since clients

generally pay for tests out-of-pocket, they can order whatever they

want or need.

 

Another advantage for the patient is that if you have your blood

tested before going to the doctor, you can skip a pricey pre-test

visit and get straight to discussing the lab results. The advent of

retail medical labs is breaking down the remaining elements of

paternalism and guild mentality in medicine and helping patients take

more responsibility for their own health care.

 

By the way, the Costa Rican lab tech called me later the same day and

told me that I didn't have parasites, but that my white blood cell

count was high and that I should expect to come down with a bad cold

in the next couple of days. I bought some cold tablets and waited. He

was right.

 

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