Blood Tests Without a Physician’s Referral : Clinic Offers Confidential, Comprehensive Profile--From Cardiovascular Risk to AIDS
In the last decade, the business world has provided increasing avenues for consumers to check their health without the intervention of doctors: do-it-yourself pregnancy tests, at-home colon cancer checks, digital blood pressure monitors, biofeedback machines and more.
But some of the most precise and revealing health tests--those dealing with blood--generally have been unavailable to consumers. In most cases, blood tests, which can reveal everything from cholesterol levels to the presence of sexually transmitted diseases, can only be obtained through physicians or health professionals who refer clients to a blood lab.
Until recently, that is.
Late last year, an enterprising doctor set up what may be the country’s first blood-testing clinic in which consumers can receive the confidential results of any blood test without being referred by a physician, nutritionist or other qualified individual.
Given the longstanding tradition of doctor-ordered blood testing, the move has brought warnings from the medical profession on possible dangers that could come from giving consumers direct access to technical information regarding their health.
But Dr. John Levin, 35, an emergency-room specialist who works at several Los Angeles area hospitals, said he was aware of potential criticism when he opened Health Profiles in West Hollywood in December to offer consumers blood testing on the spot, no appointment necessary.
Levin said he believes the clinic is the first of its kind in the country and expects to franchise offices elsewhere across the country.
“Why shouldn’t you be able to get a blood test on your own, without an appointment, without seeing a doctor for a physical?” asked Levin, who is also the inventor of a barbell grip marketed by fitness maven Joe Weider, a credit card receipt organizer sold by mail order, children’s pillow shams that resemble animals, an excuse-a-day calendar and a number of other inventions and novelties not yet on the market.
Other Interests
Levin also spends a fair share of his time purchasing properties, designing buildings (including his own home in Beverly Hills) with Los Angeles architect Mark Palmer, serving as contractor and then selling the properties.
On a recent afternoon at his West Hollywood clinic, Levin apologized for being tired.
He was working on two hours’ sleep because he still puts in about 50 hours each week in emergency rooms in addition to his other activities, he said. But he was enthusiastic about the possibilities for expanding his blood-testing clinics, saying he had already scouted locations in the San Fernando Valley, the South Bay and New York.
He said he got the idea for the blood clinics about nine months ago, when a friend asked him where a person could obtain a confidential blood test. Levin said he could think of no facility where blood tests were available without referral from a health-care professional who would most likely do a physical exam as well. The doctor said he immediately recognized the potential of opening just such a referral-free, physical-exam-free clinic.
Two months later, in December, 1985, Health Profiles opened. It is managed by Patricia Franken, a registered nurse and licensed phlebotomist (person qualified to draw blood). Available tests can profile cardiovascular risk, hepatitis, AIDS, allergies, vitamins, herpes, blood-type, thyroid, liver function and more.
According to Franken, the clinic serves three or four clients a day. The most popular request is for a comprehensive body-chemistry profile of 27 tests offered at $45. The least-expensive test is a $10 glucose test; the most expensive is a $225 vitamin profile.
Asked if there is much of a demand for AIDS testing, Franken replied that it amounts to a relatively small portion of the business.
Although referrals are not needed, most patients come with one from physicians who don’t offer blood testing in their offices, from diabetics’ organizations, from nutritionists, acupuncturists and other health-care professionals. And some clients come in response to the company’s direct-mail advertising, she said.
Typical Test
In most cases, Franken draws a sample of a client’s blood, which is then sent to a lab. Results are returned within 24 hours, reviewed by Levin or one of his two silent partners, both physicians. Then the results are mailed to or picked up by the client.
A brochure states, “Health Profiles does not replace your physician but helps you know when to seek medical advice. Our service also helps you to better communicate with your doctor. We discourage self-diagnosis and recommend all tests be discussed with your doctor. It’s important to know that even a normal test result does not rule out medical disease.”
Said Levin, “We’re not trying to replace anyone’s physician. We’ll even refer people to a doctor if they want one.”
But if it’s just a blood test that consumers are after, Levin said he is pleased to provide it. “Doctors wouldn’t do just a blood test,” he said. “They’d also give you a physical exam and charge you $100 to $300 depending on the physician. As soon as you lay your hands on someone as a physician, you generate a bill.
“Routine physicals are pretty much a waste. . . . The chances of finding something on a routine physical exam are negligible--unless there’s a complaint.”
He compared physical examinations (as opposed to blood testing) to “looking at a car and saying that it needs a paint job. . . . We test the engine here.”
Some Have Reservations
Not everyone in the medical community agrees with that assessment.
According to Dr. Richard Corlin, a Santa Monica internist and gastroenterologist who is a past president of the Los Angeles County Medical Assn., there are some isolated cases in which blood tests provide results when a doctor’s physical examination cannot. “But more often than not, the value is in the (doctor reviewing the patient’s medical) history and in the physical examination. It’s the history and the physical that can show early symptoms which lead to early finding of disease. Many times laboratory tests are going to be normal,” he said.
Corlin, who said that he suspects his view may be widespread among internists, nonetheless believes a blood-testing service like Health Profiles “is not likely to directly hurt anybody.” But he said he is concerned about the person “who gets a normal test and therefore doesn’t see a physician to get some symptoms checked out until it’s too late. . . . If a given test is normal, based on some partial knowledge and information, it may give people a false sense of security.”
Corlin said test results should be correlated with a physical exam and review of patient history by a physician. As he put it: “We don’t treat laboratory tests; we treat patients.”
Dr. Bruce Hensel, medical editor of Family Circle magazine and a friend of Levin’s, predicted response from the medical community on the subject of exam-free, referral-free blood testing will be mixed.
He said the idea “makes a lot of sense,” if people don’t have symptoms.
“The danger is that people would just use these things instead of seeing their doctors,” said Hensel, an emergency-room specialist and actor who plays a physician on the TV soap opera “Capitol.”
Fostering Communication
“These things (blood tests) should be used to foster communication with doctors rather than decrease it. Especially if you have symptoms you shouldn’t just go to the blood clinic, you should see a doctor.”
Like Levin, who he met several years ago at a health club, Hensel has career interests that extend beyond medicine, interests he believes make them both better doctors.
“A lot of doctors are uni-dimensional,” he said, “and part of that is because learning medicine takes a lot of devotion. Emergency medicine does take an awful lot out of you and it may be part of the reason it’s necessary for people like John and myself to do other things. The attitude is: We’re giving an incredible amount of time as public servants; doing other things is our sanity. People could see us either as Renaissance men or schizophrenics.”
