Healthcare costs need to be discussed with patients in the exam room

Why don’t patients and their doctors talk about healthcare costs?

Choose the best answer:

A. The doctor doesn’t bring it up.
B. Patients are too embarassed to say cost is a concern.
C. Patients assume docs can’t do anything to address the cost.
D. Doctors don’t have sufficient knowledge to discuss costs.
E. All of the above

Correct answer: E

Doctors don’t bring up the cost of prescriptions or testing with their patients.

In a study from the Archives of  Internal Medicine, one out of three chronically ill patients surveyed reported that their doctor never brought up the issue of cost. Of these respondents, almost half of them reported that they were too embarrased to bring up the matter of cost with their docs. And over half believed there was nothing their doc could do to affect the cost of the prescribed medicines and tests.

An earlier study from Archives of Family Medicine quizzed docs on the price of 50 commonly prescribed medications. No surprise — only 23% of the family medicine docs in the survey correctly identified the prices. The prices of branded (non-generic) medicine were underestimated 90% of the time. Generic prices were overestimated 90% of the time.

So why does it matter? Because when patients can’t afford what we docs prescribe, they go without or they take medicine inappropriately, such as taking half doses to make the medicine last longer. And they go without screening and diagnostic tests. And this is dangerous. And counterproductive. And a big fat waste of our collective healthcare resources.

We docs need to open our mouths and start the dialogue about individual healthcare costs with our patients. As a doc, if we don’t feel comfortable about our knowledge of what stuff costs (and 3/4 of us aren’t) then we need to educate ourselves. Go to and see what medicines and testing price ranges are. Better still — have your staff run down prices in your area of the tests and medicines you commonly prescribe.

Is it time consuming and a pain? You bet. But we need to do it to make sure we are practicing effective medicine.

Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.

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  • Edward Stevenson

    Well said. we will never reduce costs as long as we are denying exist or or have importance.

    I think your website is great. what is being done to expand it to other cities and states?

    • Leslie Ramirez

      Thanks for the positive feedback, Ed. Indeed, we are looking into expanding the site to the communities with the greatest numbers of uninsured: Florida, Texas, California and Arizona.

  • JPB

    I had one doctor get extremely annoyed with me when I told him that I couldn’t afford the drug he had prescribed. And no, he did not offer an alternative Rx. I also have had doctors tell me that they didn’t know what the cost of their services would be…..

  • Annie Stith (@Gr8fulAnnie)

    Hey, Leslie!

    Well written article and a timely topic. I struggle every month to get all of my meds. I’m on MedIcare because I’m disabled, and I have a supplemental policy. I have meds for Fibromyalgia, Osteoarthritis and Bipolar Disorder, along with a couple more for the odd Dx here and there.

    Two weeks ago, I was out of one mood stabilizer, one antidepressant and a GERD medication. When I got my disability check on the 3rd, I had to make choices about which meds I could refill. I’m back on my Bipolar meds, but now off of my allergy pills, triglyceride lowering med and my breakthrough pain pills.

    I am constantly reminding my two docs when they want to switch my meds that my finances are part of the equation. The first question is always, “Does it come generic?” If not, I generally can’t afford it. And I’m really frustrated with the fact that I can’t always get the med that would work best for me because they’re more expensive than I can afford. I also haven’t been able to confirm exactly where my OA is because of the cost of the tests.

    I understand part of the Health Care Reform package is to close the “donut hole” for Medicare’s prescription coverage. In fact, I got excited when I first heard it. Then I found out it’s only by a percentage here and there, which really won’t help me out.

    Something’s eventually got to give somewhere. My medical expenses are so high I no longer have car insurance since June for a car I couldn’t renew the license plates for in April, which has meant parking my poor 20 year old car, maybe until next year’s tax return–if Missouri doesn’t cut my credit out of the budget.



  • Edward Pullen MD

    I often bring up the topic of cost of medications with my patients, and the range of response is all over the place. I hear everything from patients wanting to save costs for themselves and the healthcare system to feeling since it’s not their money they just want “the best” available, to some patients just thinking it’s wierd that I bring it up. More and more people appreciate the opportunity to save on drugs though. It’s more of an issue with expensive testing. Get the MRI/CT scan/etc now vs. watch a bit and maybe not need the test. Also many specialists won’t even do a consultation without multiple tests done first.

  • Max Power

    Does this surprise anyone?

    Our third-party quasi-socialized health care system has successfully conditioned everyone involved to never consider the price of the service or product that is being provided/purchased. Why? Because 80% of the time someone else pays some or all of the bill.

    Want to know the solution? When was the last time you saw your auto-mechanic and failed to discuss price? When was the last time your auto mechanic was able to get away with doing a bunch of unnecessary tests and procedures (on a similar order as physicians do)?

    Until the patient is paying directly for the bulk of their health care, price will simply be overlooked. Like the hungry man at the buffet who doesn’t have to worry about how much his 2nd or 3rd go at the dessert bar will cost, so do our physicians and patients fail to consider the cost of the extra CT or the brand-name drug, for no other reason than, to them, the price has already been paid.

  • Dr. Grumpy

    I usually discuss medication costs, and use ePocrates on my iPod to look them up. I think it’s important for people to have that info when deciding on treatment.

  • Shirley Mc

    Very interesting and informative Dr.Leslie. Good Luck with going nation wide. especially Texas???? Our PCP is very conscious about Drug Cost. He always refers us to places that are cheaper. Heart Docs do not. Have to ask for a Generic???

  • C. W. Spencer

    Dr. Ramirez:

    Your article was excellent, I was impressed by Leslie’s List. Not only the uninsured, but folks with High Deductable Health Insurance Plans would find this eye opening.

  • Caroline Andrews

    My husband and I have found that it’s hard to get an answer about costs even from the billing office. It’s a real problem, especially for a patient with a high deductable or no insurance.

  • Bill

    I agree we need transperancy in pricing for health care services.As someone that has a HDHP, I am especially conscious of the procedure codes that are used for billing, and have to be vigiliant in the use of those that are for preventative services. It is very frustrating when an insurer denies a claim and the provider will not give the patient the same price as they do to the insurer that denied the claim! Then the patient cannot have a cash discount as they have insurance, even though the insurer denied the claim, so in essence the patient through claim denial has no insurance, but has insurance!

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