BEAUTY OF A DEBATE PHYSICIANS ARE OFFERING SPA SERVICES - BUT IS IT A NEW KIND OF CARE OR A BIG CASH-IN?

Byline: Mariko Thompson Staff Writer

Joan Robinson loves a good pampering. For a holiday treat, Robinson, a retired school teacher, and her daughter Cathy booked facials and massages - not at a traditional day spa, but at the offices of her ob-gyn.

The Ocean Oasis medical spa, founded by Dr. Lisa Masterson in Santa Monica, combines a gynecological practice with stress-reduction therapies found at the typical day spa. The fusion of medicine with the beauty industry is causing critics to raise a perfectly waxed eyebrow. But to Robinson, the set-up makes sense.

``I think she's treating the whole woman,'' Robinson said. ``A lot of our health problems come from stress. This is a form of preventive medicine.''

The medical spa - also called medi-spa - isn't a wacky L.A. concoction. According to the Day Spa Association, more than 400 medical spas have opened around the country and represent the fastest-growing segment of the spa industry.

``Many cultures in Europe and Asia have used the baths or the spa as a healing environment, not a beauty environment,'' says Hannelore Leavy, the association's executive director. ``It's interesting to see the spa concept coming back to the basics. The medical professional is finally starting to realize the old methods have some truth and value.''

The trend, which the Day Spa Association says emerged about three years ago, doesn't sit well with medical ethicists. Offering spa services to attract high-end patients is certainly legal. But experts in medical ethics say that such commercial endeavors have the potential to undermine the trust between doctor and patient.

A doctor recommending a facial exerts an influence far greater than a friend recommending a cosmetologist, said Miriam Cotler, professor of health sciences at California State University, Northridge, and a bioethics consultant.

``I think it raises fundamental ethical questions,'' Cotler said. ``This is a boutique product. These services conflict with the concept of need in medicine, which is the relief of pain and suffering, prevention of disease and restoring people to a function.''

Dr. Leonard Morse, chairman of the American Medical Association's Council on Ethical and Judicial Affairs, said it's not unusual for doctors to own other businesses, including laboratories or companies selling medical products and equipment. Under the council's conflict-onterest guidelines, doctors should disclose their financial interests when making referrals to their own businesses and should provide alternatives. Patients should not be made to feel their care will be compromised if they opt for another facility, Morse said.

``The doctor cannot be in an advantageous situation,'' he said. ``It's OK as long as there's no exploitation or coercion and as long as the patient has a choice.''

What's your pleasure?

The medical spa appears in a number of forms. Some spas hire doctors. Some doctors hire aestheticians and massage therapists. Sherman Oaks dentist Eddie Siman puts his own twist on the concept. At Millennium Dental, spa services are a perk for patients, who can choose one treatment free of charge while they're in the dentist's chair.

Breathing in the scent of an aromatherapy pillow, the patient can opt for a foot massage, manicure or pedicure. Those who don't want spa services can arrange to have their cars washed or watch their favorite movie on DVD.

``Our patients enjoy it,'' Siman said. ``There are always some who say this is too much. We don't force anybody to take a treatment. It's not mandatory.''

Siman, who describes himself as a ``smile make-over specialist,'' displays before-and-after photos of patients who had cosmetic work in his consultation room. Two years ago, Siman closed his Beverly Hills practice and designed a stand-alone dental office of sandblasted glass and stone on a busy stretch of Ventura Boulevard in Sherman Oaks. Soft music pipes through the office, painted a soothing sky blue. The windows are designed so that the reclining patient sees the sky.

All of the dental equipment is tucked away, out of the patient's view. On a network of computers, Siman can pull up a patient's chart, review digital X-rays, and run a program that will show the patient what their cosmetic work will look like once finished. By incorporating spa services and technology, Siman hopes to erase fears many people have that dental work will be painful.

``In any service-oriented business, you have to go the extra mile,'' he said.

Face value

Like Siman, Dr. Marcia Glenn has gone to great lengths to create a comfortable setting that doesn't feel clinical. Glenn, a dermatologist in private practice and also director of the pediatric dermatology clinic at King/Drew Medical Center, opened the Odyssey MediSpa in Marina del Rey in December. Every morning, she lights candles in the medical exam rooms, which have been painted a buttercup yellow and designed with mahogany counters.

Glenn's dermatology patients used to ask if they could get facials done in her office. So adding spa services seemed like a natural extension, she said.

``I come from an entrepreneurial family, and I thought I'd like to have a second business,'' she said. ``I wanted them under one roof, both for the ease of the patient and recognizing that I only have so many hours in one day.''

At Odyssey, where facials run about $85, patients and spa clients have their own waiting areas furnished with plush chairs. The medical side also includes a plastic surgeon, a chiropractor, an internist and a dietitian. The spa side has aestheticians, massage therapists and soon will add a nail and hair salon. Spa clients don't have to be medical patients. Billing for medical and spa services remain separate, Glenn said.

Aesthetician Jamaina Haney said the partnership results in better care for spa clients.

``I've had people with (advanced) acne come in for facials,'' she said. ``Instead of adding products that will add to the irritation, I can refer them to a dermatologist.''

Likewise, Glenn can treat a scalp condition, but can't make recommendations on a new hairstyle.

``People want high-end services, whether it's laser, Botox or chemical peels,'' Glenn said. ``How nice if these services can be given in a supervised setting where there's less chance for mishap.''

Babying the patients

On the surface, dermatology and spas might seem to share more common ground than gynecology and spas. But Masterson, the obstetrician-gynecologist who opened Ocean Oasis in a white 1905 Victorian overlooking the Pacific, sees plenty of overlap in her field as well.

On the ground floor, patients can get their pap smears and their ultrasounds. Then they can head upstairs for a pregnancy massage, a labor-inducing massage, or an estrogen facial. Those in the mood for straight pampering can opt for hot stone therapy, bikini waxing or a couples massage. Like Glenn, Masterson says most spa services are out-of-pocket expenditures that aren't covered by insurance (a bikini wax runs $25, while an estrogen facial will cost you $90).

``When you think about women's health and medicine, it's a nurturing thing,'' Masterson said. ``Female issues include sexuality, relationships, pregnancy, sometimes cancer. So we deal not only with the medical part, but also the psychological part.''

Masterson always envisioned having her practice in a house. She saw a feminine, relaxed atmosphere as key for patients about to undergo an uncomfortable exam. The waiting room has large bay windows with ocean views. Patients disrobe behind folding screens in rooms with hardwood floors. Spa clients can enter the house through the back yard and can lounge over tea on the balcony.

``It can sound a little frou-frou,'' Masterson said. ``But really, as long as you're making the person better, then why not? An ob-gyn office is a business. We weren't sent to business school and we still have to know how to run a business. I don't give massages. I don't delve into things that I can't do, but I have the best people doing them.''

These dual roles of medicine as a helping profession and medicine as a business are at the heart of the tension in the ethical arena. For bioethicist Cotler, medical spas fall too far on the side of commercialism.

``What recommends us to a physician or dentist should be their competence, their caring and their outcomes,'' Cotler said. ``It should not be because they offer a great manicure.''

Glenn says such criticisms underestimate patients, who have become increasingly savvy when it comes to health care.

``Patients are so sophisticated these days,'' she said. ``They go to chiropractors and acupuncturists. They see that traditional medicine hasn't always worked for them. The key here is they have to demand excellence in their medical professionals and their aesthetic professionals.''

CAPTION(S):

5 photos

Photo:

(1 -- cover -- color) ON THE COVER: At Millennium Dental in Sherman Oaks, Carla Hammer gazes at her manicure while dental assistant Cece Dempsey and dentist Eddie Siman work on her teeth.

(2) At left, Hammer also receives a manicure from Stern during her appointment.

(3) Carla Hammer gazes at her manicure while Millenium Dental's Cece Dempsey works on her teeth.

Charlotte Schmid-Maybach/Staff Photographer

(4) Nurse Karin Johnston consults a medical book at Ocean Oasis, an ob-gyn office and spa in Santa Monica that overlooks the Pacific. Patients there can get an ultrasound and an estrogen facial under one roof.

(5) At Ocean Oasis, aesthetician Diane Harper gives a massage to Cathy Robbins.

Tina Burch/Staff Photographer