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More About Costs of Care

Posted 2/26/2013

Posted in

  This is an essay from the New York Times that is related to yesterday's post. There are at least two central themes and bottom lines in this debate: As a country we cannot afford runaway health costs; we have to make some changes. And every patient deserves the best possible care, and we are committed to supporting care decisions made between a doctor and a patient. This may be especially true and important in cancer care when the stakes are so high.

  It is all too easy to be eloquent and consider policy and costs and national issues when it is a theoretical patient or situation. When it is you or your spouse or child, it feels quite different. Many doctors are pretty uncomfortable talking directly about prices (which really is what we mean when we say "costs") to their patients. They surely have not been trained to give patients the equivalent of a shopping list and a budget. Some oncologists in private practice have more experience with this issue than their colleagues at medical centers. In some practices, the doctors basically buy all the drugs and then resell them to patients, so the considerations of price are more apparent. When the question is about whether to order a CT scan (cheaper) or an MRI (more expensive) or maybe wait before ordering any test at all, it is a less concrete conversation.

  Here is the beginning and then a link. Like it or not, this is a topic in which we all must engage.

FEBRUARY 21, 2013, 11:46 AM

Getting Patients to Think About Costs



A colleague and I recently got into a heated discussion over health care spending. It wasn’t

that he disagreed with me about the need to rein in costs; but he said he was frustrated every

time he tried to do so.

Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a

patient who had been suffering from headaches. After a thorough examination, my colleague

was convinced the headaches were the result of stress.

But the patient was not.

“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained

his conclusions several times, proposed a return visit in a month to reassess the situation

and ran so far overtime that his office nurse knocked on the door to make sure nothing had

gone awry, the patient continued to insist on getting the expensive study.

When my colleague finally evoked cost – telling the woman that while an M.R.I. might ferret

out rare causes, it didn’t make sense to spend the enormous fee on something of such

marginal benefit – the woman became belligerent. “She yelled that this was her head we

were talking about,” he recalled. “And expensive tests like this were the reason she had

health insurance.”

Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he

finally said. “But are our patients?”


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