Bedside manner may need to include cost of care discussions

by Dennis Grace

For years, if you asked for a recommendation for a physician, the answer included some mention of bedside manner.

I mean, we’re human beings first and patients second, so we think it’s great that she’s a brilliant doctor, but is she pleasant? Is she respectful and patient? Nobody wants to work with a know-it-all, especially one who gets to hear about our bowel movements and stare at our genitals.

These days, knowledge of the cost of care is becoming an important component of bedside manner. Most anyone over forty has had the experience of a doctor cheerfully prescribing a drug that would cost fifteen dollars a day or blithely ordering a test that costs as much as a used car. Until 1998, apparently, doctors just weren’t taught to take costs into consideration. Before that time, doctors who did know about the costs were real go-getters.

Fortunately, as detailed in an article in the New York Times that kind of insensitive behavior should be going the way of the dinosaurs. Doctors are learning that they have to know the cost of the procedures and drugs they order, and understand the impact of those costs on their patients. The bad news is that this knowledge is getting out sloooowly. Many physicians simply don’t have the message yet.

So, what can you, a knowledgeable and cost-conscious patient, do to be sure your doctor is in the know on the cost of drugs and surgery? Well, you could come right out and ask how they factor costs into their work, but with office visits being shrunk down more and more these days, such casual conversation rarely seems to fit the schedule. Instead, you might hit him where it matters. When he prescribes a drug or orders a procedure, just ask, “Is this going to be expensive?” Better still, ask how much it will cost. A cost-aware doctor will answer your question or at least politely excuse himself and go find an answer.

And the rest, the not-so-cost-aware? Well, they’ll say something like, “You’ll have to ask the pharmacy (or lab, or surgeon).” For something complex, they might say, “Well, my portion will be covered by your insurance, but I don’t know about the rest.” The really snotty, easily-offended, know-it-all physician will say something like, “How can you ask questions like that when we’re talking about your health?” Most of these answers are warnings that you need to consider other options (and when I say “other options” I mean “other doctors”).

And if the doctor tells you the cost, and it’s too high? Ask about alternatives. If it’s a drug, ask about generics. If it’s a test, ask if a simpler test won’t provide enough information. Before you go in for an MRI or CT scan, know what additional information the doctor expects to gain from the test. Is that gain worth the cost of the test?

If you’re really lucky, as is often the case with my pulmonologist, he’ll give you free samples. (Disclaimer: Doctors rarely offer free samples of MRIs.)

Dennis Grace is co-founder of and blogs at The BillDog Blog.

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