Doctors missing chances to talk about costs
Kaiser Health News
Washington — Talking about money is never easy. But when doctors are reluctant to talk about medical costs, a patient’s health can be undermined. A study published in this month’s Health Affairs explores the dynamics that can trigger that scenario.
Patients are increasingly responsible for shouldering more of their own health costs. In theory, that’s supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous services alike.
Doctors could play a key role in instead helping patients find appropriate and affordable care by talking to them about their out-of-pocket costs. But, a range of physician behaviors stands in the way, according to the study, released Monday.
“We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” said Peter Ubel, the study’s main author and a physician and behavioral scientist at Duke University.
The researchers analyzed transcripts of almost 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested that the cost of care might be difficult to afford and assessed how doctors responded.
Overall, researchers noted two ways in which doctors dismissed patients’ financial woes. They either did not acknowledge the concerns patients expressed or only halfaddressed them. For instance, if a patient commented on how expensive a drug was, the doctor might ignore the comment entirely or might suggest a temporary solution — like a free trial — without exploring long-term strategies.
And, without such a longterm plan, patients may eventually stop taking the medication, or take it irregularly. That can harm their health, and even send them to the hospital.
Why do physicians hesitate? For one thing, they aren’t used to discussing cost barriers, and many think it’s inappropriate to bring up money at all, Ubel said.
Plus, doctors haven’t been taught to listen for patients’ pocketbook concerns. If a patient comes in with heartburn and indigestion, a good internist will immediately start probing for signs of coronary disease, Ubel said. By contrast, physicians aren’t primed to pick up on cues that patients may face financial strains.