Testing made easy
Direct-from-lab medical results can give patients more power, but they might also harm the unwary
Patient complaints. The trouble is this sort of doctor-patient relationship hasn't really existed since Marcus Welby, M.D. went off the air. "HMOs are only allowing certain tests and limiting how often you can be tested," complains McKee, 58, of Santa Ana, Calif. "I was feeling bad, and I hadn't seen my doctor in a year. He never listened to me." Wainwright, 42, of Searcy, Ark., adds, "You know how many times you ask a doc for a specific test and he says, `Oh, you don't need that.' " She has dangerously high blood pressure, uncontrolled by the medication her doctor prescribed, and she wanted more tests. So she used a test from HealthcheckUSA, "which will even come to where I work to draw blood, and they listen to what I want." And the Texas cancer patient used a direct access company for his prostate specific antigen test because he didn't want his insurance company to know he had cancer. "I was afraid they would drop me or raise my rates."
The trick, then, is to get the best of both worlds: quick, convenient, confidential tests, plus the benefit of a doctor's knowledge to interpret them. Services like HealthcheckUSA and QuesTest push doctor consultations hard in their literature. "We certainly tell customers to see a doctor," says Holt Vaughan, executive vice president of HealthcheckUSA. But simply saying it may not be good enough; services vary in how deeply they involve a doctor in providing results. Physicians not only review customer requests of QuesTest but also look at the results and sign off on them. They will call a customer if a lab result appears unusual. At HealthcheckUSA, the doctor's role is more removed. The physician signs a paper authorizing the test in order to comply with state laws, says Vaughan. And that physician won't necessarily review the results; they might be evaluated by a lab technician.
To get her tests and expert advice, Levine has reached an agreement with her doctor: She talks to her physician, they agree on the tests she should order, she does it, and she shows the doctor the results.
Then there's the matter of ordering the appropriate test. Many thyroid patients, Levine and McKee among them, have become convinced that they need a free T3 test to detect a specific thyroid hormone. They've dumped doctors who order only a more general test for TSH, or thyroid stimulating hormone. Free T3 is available from HealthcheckUSA as part of a $75 test. Yet it may not be worth ordering, says Hossein Gharib, a thyroid specialist at the Mayo Clinic in Rochester, Minn., and president of the American Association of Clinical Endocrinologists. "Hey, we live in a free world, but it's not a `free T3' world. TSH is the gold standard for thyroid function," he says. "T3 tests are not very reliable. And you would only try one if the TSH is abnormal." Yet patients with normal TSH who still feel lousy insist a further test can pinpoint their problem.