By Dennis Thompson
WEDNESDAY, Oct. 16 (HealthDay News) -- Doctors should consider the "toxic" effects of medical debt as much as any other side effect when discussing treatment options with patients, a trio of physicians contends.
By not making potential expense a part of the conversation regarding treatment options, doctors are exposing patients to financial troubles that could compound their health struggles, the Duke physicians wrote in an opinion piece in the Oct. 17 New England Journal of Medicine.
"Since health care providers don't often discuss potential costs before ordering diagnostic tests or making treatment decisions, patients may unknowingly face daunting and potentially avoidable health care bills," the physicians wrote. "Because treatments can be 'financially toxic,' imposing out-of-pocket costs that may impair patients' well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments' side effects."
The physicians argue that doctors should consider financial discussions part of their traditional duties, even if they need to receive more training to better understand the expense of treatments to patients.
Nearly two-thirds of personal bankruptcy filings in the United States are due to medical debt, according to the nonprofit National Patient Advocate Foundation. Families run up overwhelming medical bills treating a seriously ill loved one.
Previous studies have shown that more than half of patients want to talk with doctors about the costs of treatment options, but only 19 percent actually have that conversation, said paper co-author Dr. Yousuf Zafar, an assistant professor with the Duke Cancer Institute and the Duke Clinical Research Institute, in Durham, N.C.
"Even though patients have this desire to bring up their growing financial burden, they hadn't had the discussion," Zafar said. "Patients say they want the best care regardless of cost, but in their mind, they link cost to quality. They believe the best care is the most expensive care, and if they talk about cost they might not get the best care."
Zafar began looking into the role of financial information in medical decision-making based on feedback he received from his own patients.
"Patients in my practice as a medical oncologist were coming to me with growing concerns about the cost of their care despite having insurance," he said. "We as physicians don't really know what all of the costs are, but that doesn't mean we shouldn't bring up the topic."
One in five Americans is underinsured, paying at least 10 percent of their annual income on out-of-pocket health care expenses, Zafar said. A serious illness could ruin these people financially.
Reviewing the potential out-of-pocket costs of a procedure can be beneficial to patients, the authors said, by enabling the following:
- Helping them choose lower-cost treatments when there are viable alternatives.
- Assisting those who want to make an informed decision about trading potential medical benefit for less financial distress.
- Allowing them to prepare themselves financially for an expensive procedure.