Physicians Lack Tactics for Discussing Medical Costs

It’s never easy to talk about financial challenges. But when the topic is avoided when doctors are talking about medical costs, the consequences can be life threatening.

In an effort to quell this issue in the future, a study published recently in Healthy Affairs explores the dynamics between physician and patients when talking about finances. The study examines the question “are physicians prepared to help patients factor out-of-pocket expenses into medical decisions?”

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It’s a topic that becomes increasingly important as patients are saddled with shouldering more of their own healthcare costs. In theory, the increased financial responsibility is supposed to make patients sharper consumers and empower them to trim unnecessary spending.

However, previous study has shown increased costs often lead to people skimping on both valuable preventative care as well as superfluous diagnostic and treatment services.

This study recognizes that doctors could play a key role in helping patients find appropriate, affordable care by talking more about the out-of-pocket costs. But a lot of work would need to be done to achieve this change, according to the study.

“We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” Peter Ubel, the study’s main author and a physician and behavioral scientist at Duke University, said.

For the study, researchers analyzed transcripts of nearly 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested the care might be too expensive and assessed how doctors responded.

Researchers found that overall physicians dismissed patient’s financial concerns, either by not acknowledging them at all or by only half-addressing them.

For example, if a patient pointed out how expensive a drug is, the doctor might ignore the comment completely or might only suggest a temporary solution – like a free trial – without exploring long-term strategies to address the problem.

And, without a long-term plan, patients may eventually stop taking the medication, or take it irregularly. That can harm their health, resulting in a potential costly hospital visit.

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Changing doctors’ behaviors likely won’t be easy, as this is a relatively new aspect to an age-old position. Physicians have not traditionally been taught to listen for patients’ pocketbook concerns, and when they do register, doctors are not accustomed to talking about cost barriers. Many might even think it’s inappropriate to bring up money at all.

Another hurdle for this conversation is that physicians are not always aware of a procedure or medication’s cost. They may be just as surprised as the patient by the high price tag of some drugs and services.

“It’s not as though, ‘Oh, it’s just consumers can’t figure it out.’ Doctors don’t know,” Jonathon Kolstad, an assistant professor of economic analysis and policy at the University of California Berkeley, said. When it comes to figuring out what a drug will cost, “doctors are in the same boat.”

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