Ability to pay for medical expenses should be a vital sign

We are a new generation of physicians and physicians in training.  The words “stem cell therapy,” “Robertsonian translocation,” and “artificial tracheal transplant” were part of our vocabulary from the first day of medical school.  At the astounding speed at which scientific advancements are made, our ability to incorporate new material is in a constant state of change.

Slowly, the heavy textbooks became relics, as we migrated towards a mobile knowledge, a way for us to carry around and receive up to date medical information at any time or place of the day.  We became the generation of iPhones and iPads, the generation who is satisfied with the ability “know where and how to find the information,” painfully aware of our inability to memorize and keep up with everything.

But in spite of the growing fluidity of the medical curriculum, it was baffling for most of us to enter the “real world” of hospitals and clinics and realize how little we knew.  While we were quite familiar with the Krebs cycle, electrolyte imbalances, rare genetic mutations, the “high-tech” seemingly comprehensive medical school curriculum stopped short. During our clinical years, we realized that our knowledge of pathophysiology was dwarfed by our unawareness of the issues that are so saliently engrained in the lives of our patients.

Not a single medical student knew what a complete blood count test would cost, or how much a patient would be billed after a night in the intensive care unit. Yet, we took pride in knowing how to enter an order in the computer and interpret an abnormal test.  We were naïve to think that our patients are “non-adherent” to medications, when in reality, they just couldn’t afford them and were too embarrassed to admit it.  These issues were foreign to us.

The definition of a “good physician” has changed in the last few years.  It is no longer sufficient to limit ourselves to medicine; we must learn to take a holistic approach towards helping our patients, and this includes a keen awareness that our best medical care could mean their bankruptcy.  In the last few years, physicians started to recognize “pain” as a 5th vital sign, in addition to temperature, heart rate, respiratory rate and blood pressure.  Perhaps it is time to consider “ability to pay for medical expenses” as a close-up runner to our list of vital signs, one that could easily increase your heart rate and make one short of breath.

We are a new generation of physicians and physicians in training.  And our vocabulary ought to include words like “cost-awareness,” “cost-efficiency,” and “cost-reduction.”  At the astounding speed at which medical costs are increasing, our minds are thirsty for more knowledge, more skills and more wisdom at how to truly become a physician of the 21st century.

Ioana Baiu is a joint degree candidate in medicine and public health.  This post originally appeared on Costs of Care.

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  • http://twitter.com/WindyCityMed Michael Mank

    Ever since I have engulfed myself in social media, healthcare policy, SCOTUS, and the true cost of care, I am really starting to see that the more informed I am, the more I want to change the system. Staying the status quo has become unacceptable to me. I will be starting medical school in August, and I keep on telling myself, “Become not just a physician, but a great physician.” As you have pointed out, this means more than having expertise in medicine, but also great knowledge in policy and making the system work for the patients you serve (no matter how broken the system is). Additionally, becoming a great physician means involving yourself with organized medicine and healthcare policy to implement the changes you think will benefit those you serve- the patients.

  • http://twitter.com/paulabramsonMD Paul Abramson MD

    The surgeons have long referred to this “vital sign” as a “wallet biopsy” ;-)

  • doc99

    When I’m ill, I want a doctor not an accountant. Concentrate on making the correct diagnosis and then the appropriate treatment. If there are two acceptable choices for treatment, consider cost. If the powers that be were sincere about reining in cost, then enact meaningful liability reform so that doctors can begin to shed the reflexive defensive practices. This will result in savings. The other choice of rationing will ultimately lead to perdition. Doctors, do not get suckered into this strawman. “Parsimonious” is just another word for stingy, appealing to baser instincts. “To Serve Man” – It’s a Cookbook!