How a medical student can exacerbate the high cost of health care

Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care.

It hit me one day, during my medicine rotation.  We were working up a patient, and I was ordering tests with my resident.  The patient had liver disease and perhaps some ascites.

He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have done much of anything inpatient to treat it.  But this was my first liver disease patient, and I wanted to see what the ultrasound would look like.

I could’ve looked it up, but it’s cooler – and easier to remember – if it’s my own patient’s.  So I suggested, in the med student leading-question fashion, “What would an ultrasound show in this case?”  My resident rationalized my request with the offhand comment “Well, it *is* a teaching hospital.”

And that’s the thing – it *is* a teaching hospital, and I am a medical student.  I learn by seeing and doing.  I didn’t think about the patient getting billed for that ultrasound.  Or that his Medicaid would get billed for it.  And taxpayers and the system would pick up the costs.  Or that the procedure wouldn’t be covered, and the patient wouldn’t be able to afford it, and the hospital would have to eat the costs.

We’re often told that “Before you order a test, think about what you’re going to do with the result.”  But that’s easier said than done.  It’s reflexive that, when you order morning labs, you order labs on everyone, sometimes those that don’t need it.  Sometimes you want to confirm your clinical diagnosis, even though you wouldn’t necessarily change your plan.  (Hey, I’m a beginning 3rd-year medical student … I like affirmation when I finally nail a diagnosis).

If I were a patient paying for my hospital stay out-of-pocket, would I be more vigilant about what tests are being run on me, how many vials of blood were being drawn each morning?  Patients don’t think about that or even know to think about that.  They trust that their doctor is doing what’s best for them.  But “what’s best for them” isn’t always what’s best for the wallet.  The doctor isn’t thinking about the wallet.  It’s not how the physician was trained.

If there were a price listed next to each item you could order in the computer system, I bet it would change behavior.  1 BMP = $15.  1 CBC = $10.  1 PT/INR = $6. 1 set of LFTs = $15.  That’s almost $50 in the average morning lab order, per patient.  I’d think twice about what I’m ordering if I were presented with a bill after my shopping spree in the computer order system cafeteria.

The reason I’m part of the cost problem is largely because I don’t know how much things cost, and I don’t think about it.

So make me think about it.  This is a teaching hospital — I’ll learn.

Suchita Shah is a medical student who blogs at University and State.

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