|Talking Money Is Touchy Subject; Doctors Must Take
Lead, Study Finds
Physicians and patients are caught in a catch-22
when it comes to money and healthcare.
Patients want the best medical care they can get
based on what their insurance will pay. Doctors want to provide the
best healthcare possible but know that what is best is not always
affordable. That’s the conclusion of two academic law
professors who said doctors have to take the initiative.
"Doctors need to make their treatment
recommendations in the context of what patients can and can’t
afford, with the understanding that some patients can’t
afford what they might recommend," says Mark A. Hall, an attorney and
public health professor at the Wake Forest University School of
He said patients are counting on physicians to
help guide them to the best treatment decisions –medically
The situation is becoming more and more serious as
employers are making their employees pick up a greater load of their
healthcare premium through higher deductibles, co-pays and
The thinking of Hall and co-author Carl E.
Schneider, a lawyer at the University of Michigan, appeared in a recent
issue of the Journal of Family Practice.
In coming to their conclusions, the two lawyers
reviewed literature on relevant professional ethics. They interviewed
primary care physicians who treat lower-income patients to see how the
physician-patient relationship is changed by the current trend.
Hall said doctors need training on how to
effectively talk with patients about money. The experienced physicians
interviewed for the study suggested asking patients not about their
ability to pay, but instead about the extent of their insurance
coverage to avoid the embarrassment some patients feel admitting they
can’t afford their doctors’ bills.
The good news for doctors is that the conversation
could stave off a medical malpractice lawsuit. Hall and Schneider found
that such conversations – and the treatment decisions that
resulted – created negligible legal issues for doctors. "If
they have an open conversation with a patient who subsequently chooses
to take a cheaper route, there’s little chance of a lawsuit
because the choice is ultimately for the patient, not the doctor, to
make," Hall said.
Patients shouldn’t have to be afraid to
talk to doctors … it’s not a new concept, he
added. It was a common practice generations ago, before
employer-sponsored health insurance was standard.
Addresses: Wake Forest University School of
Medicine, Medical Center Boulevard, Winston-Salem, NC 27157; (336)
University of Michigan Law School, 625 South State Street, Ann Arbor,
MI 48109-1215; (734) 764-1358, www.law.umich.edu.