Dear Impatient readers, you may have noticed that we’re writing a lot about the importance of asking about the cost of your health care. It’s part of our ongoing mission to give you the tools to navigate our rapidly changing medical system, particularly with regard to how much care costs.
Along the way we’ve talked about how patients – especially those on high-deductible health plans – should broach issues of cost with their doctors, even if it means having potentially awkward conversations. These discussions, experts advise, could spur doctors to be more cost-conscious when ordering tests or prescribing medications.
This week, we turn the tables and talk to some doctors who think they and their colleagues also need to be prepared to have these conversations.
Do no (financial) harm
Many doctors don’t think about health care costs, says Dr. Neel Shah, an assistant professor at Harvard Medical School. One reason for that, he says, is that they haven’t been trained to do so.
“In medical school, not only was I not taught anything about health care costs, but I was specifically taught that health care costs were not my concern,” says Shah, who’s also the founder and executive director of the non-profit Costs of Care.
Dr. Jeff Kullgren, an assistant professor at the University of Michigan Medical School, takes that a step further.
Kullgren went to medical school “not that long ago,” he says. The professors there taught him that a patient’s “ability to pay for a service should not be a major factor in deciding what kind of health care that patient needs,” adds Kullgren, who is also a research scientist at the Center for Clinical Management Research at the Veterans Affairs Ann Arbor Health System.
Both doctors have since rebelled against this part of their education. They say they’ve realized that as the health care system changes, the ethos to “do no harm” must include patients’ finances. Shah and Kullgren argue that turning a blind eye to the cost of care only allows costs to mount – both on the system and on individual patients.
Shah recalls that as an intern at a hospital, he would order MRIs without knowing their cost. (Impatient readers might recall that another doctor told us last summer that he, too, had ordered thousands of ultrasounds and CAT scans over the course of his career without ever knowing their prices.)
“If you’re ordering off a menu that doesn’t have any prices on it, it’s very easy to get filet mignon everyday,” he explains. And more and more patients are struggling to pay for that filet mignon out of their own pockets, Kullgren points out.
What patients care about
Doctors may not have been taught to consider health costs, but that doesn’t mean they’re averse to discussing them.
No matter how it begins, the conversation is worthwhile – and should he happening more regularly, says Dr. Peter Ubel, a physician and behavioral scientist at Duke University who frequently writes about health costs.
Like Shah and Kullgren, Ubel believes doctors need to take a more proactive role.
Just as a financial advisor talks to a client about short- and long-term goals before suggesting a retirement savings plan, doctors should spend five minutes finding out what their patients care about before giving medical advice, he argues.
“Sometimes the best alternative is what the patient cares about,” adds Ubel.
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