Consumerism in healthcare and the Physician-Patient Relationship

On PsychCentral.com, Dr. Rick Nauert writes in this post entitled Money Changes Physician-Patient Relationship – 

“We have forgotten that aspect of professional folk wisdom,” Hall said. “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.”

Dr. Nauert interviewed Dr. Mark A. Hall, a professor of law and public health in the Division of Public Health Sciences at the School of Medicine, Wakeforest University.

Dr. Hall is co-author of this interesting journal article with Dr. Carl Schnider –

The Patient Life: Can Consumers Direct Healthcare. American Journal of Law & Medicine, 35 (2009): 7-65.

In this article, they discuss the demanding prerequisites of consumerism in healthcare:

First, consumers must have choices that include the coverage, care-takers, and care they want. Second, reliable information about those choices must be available. Third, information must be put before consumers, especially by doctors. Fourth, consumers must receive the information. Fifth, the information must be complete and comprehensible enough for consumers to use it. Sixth, consumers must understand what they are told. Seventh, consumers must be willing to analyze the information. Eighth, consumers must actually analyze the information and do so well enough to make good choices.

Requirements 1-6 require the participation of the physician, especially number 3. But are doctors willing to talk about money matters with their patients? Do physicians consider the services they provide a commodity? This is an important issue not only locally where most of healthcare is out-of-pocket but elsewhere where co-pays are increasing. How is consumerism in healthcare affecting the physician-patient relationship?

Sachin Jain writes on Forbes.com,

In thinking about the healthcare consumer, we must not forget that people afflicted with serious illness always prefer being considered and cared for as “patients” instead of as “consumers.” To unlock the true potential of the consumer-driven health care movement, we need a more complete model of these patients, their goals, and their priorities. Accessing health care is far different from making a purchase at the local mall—and it always should be.

Let’s talk about the money on 24 September 2016 9 pm Manila time at the #HealthXPH tweet chat.

T1 Should doctors discuss with their patients the patient’s ability to pay for treatment? Why or why not?

A patient who comes to the clinic for the first time has a diabetic foot infection. He needs admission. In my setting, he has the option to get admitted in the pay or the charity ward. I find it tricky to discuss these options when it is my first time to see the patient and I haven’t had time to build rapport yet. Who should raise the issue of cost first?

From myhealthandmoney.com –

Now that costs are driving more of our healthcare decisions, one issue that keeps coming up is whose responsibility is it to initiate the cost conversation — the patient or the provider?

… We can’t truly take control of our healthcare spending and family budget, if we aren’t willing to take control of the conversation. Therefore, if the doctor doesn’t bring up the cost of a treatment, then make a promise to yourself that you will, and be done with sticker shock.

T2. How can doctors ethically discuss cost of treatment with patients, without offending them?

A patient comes back to see me and confides that he has not been taking his medication. I find out that he cannot afford the medicines prescribed. I gently suggest generic medications but he says he does not trust these and feels offended at my suggestion. He says he will try his best to raise money for his medications. I wonder if I should have brought it up at the preceding visit.

T3. How should doctors respond when patients ask for discounts from their professional fees?

My patient is about to be discharged. Her relative asks if I can give a discount. Anyway she says I am affluent and can afford to be charitable. How should I respond? I remember one of my attending physicians who was asked for a discount during rounds. She said, do you ask for adiscount when you go to your hairdresser? You don’t right, and you even give a tip.

What do you think? See you at the tweet chat!