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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