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Doctors urged to be more mindful of costs of procedures they order





















When McKoy was in medical school more than 20 years ago, she said she was taught to go after the disease and get to the bottom of it, no matter what it took.

"We were trained to see the gallbladder, the back pain, the chest pain, not the patient," she said.

Because medical care is so expensive, and so many patientsare underinsured or insured but with high deductibles or copays, doctors have an ethical obligation to think broadly about their patients, including their costs, she said.

"I have a patient right now with a heart condition who won't take her medications because she can't afford it. She tells me, 'Doctor, I'm so worried about the cost,'" McKoy said. "Because I know this, I can think of alternatives." 

McKoy believes that doctors must understand what their patients can afford; not to ration care but to find alternatives that patients, like her heart patient, can afford. This is so important to McKoy that when she taught a medical school class on the patient, physician and society, she would give her students an actual hospital bill and ask them to write a short essay about it.

"Patients need to know what they are getting into. They can lose their houses or their children's tuition money on medical care," said McKoy, who also has a law degree and a master's degree in business administration. "Patients have a right to know those things, and we don't tell you that."

By using evidenced-based research and avoiding a shotgun approach to testing, doctors can reduce medical costs without compromising care, Weinberger said. If a person is diagnosed with cancer and needs expensive chemotherapy, by all means he or she should get it, he said.

"But there is a lot of care that does not help patients, and in some cases actively harms them, and that we need to get rid of," Weinberger said.

Ira DuBrow, a pediatric cardiologist at Advocate Lutheran General Children's Hospital, believes that doctors should be ombudsmen for their patients and their pocketbooks. He can rattle off the cost of every medical test, procedure and drug he orders. He will tell anxious parents when an expensive test they ask for is no more effective than a cheaper one, and dispense with advanced and pricey diagnostic gadgetry altogether in favor of an old-fashioned hands-on examination, he says.

DuBrow also believes medical students should be taught early on to know what costs look like, as he put it, "on the other side of the stethoscope." Too many doctors are oblivious to the costs of care, and that is costing the country a lot of money without any corresponding benefit, he said.

"There are few things I'm dogmatic about, and I'm dogmatic about this: Someone is paying for this someplace," he said.

This spring, Brendan Bouffard, then a law student living in Oak Park, walked out of a local hospital emergency room, he said, after no one could tell how much a CT scan a doctor had ordered would cost. He went to the hospital with a migraine and bleeding in his left eye, after throwing up all night. The doctor who saw him seemed to be fairly certain that the bleeding was from a burst blood vessel in his eye, but ordered a CT scan on his brain to make sure, said Bouffard, now a lawyer in Williamston, Mich., who remains in good health.

Bouffard's health insurance required a 20 percent co-pay, and he asked a nurse about how much the CT scan would cost. She told him it could be between $2,000 and $10,000, he said.

"The doctor didn't seem to know either, and I told him that I couldn't risk getting a bill for $2,000 and not even knowing how much the total would be until the bill came in," said Bouffard.

The doctor told him to come back if he got worse, an answer that Bouffard didn't find completely satisfactory. Bouffard said he left without treatment.

Last year, Costs of Care sponsored a popular essay contest that crowdsources hundreds of anecdotes from doctors, medical students and patients of how the system is failing patients. One of the finalists was cardiovascular surgeon Grayson Wheatley III, from Phoenix. Wheatley described how despite his efforts to make sure that all the care for a surgical patient was in the man's insurance network, the anesthesiologist assigned by the hospital for the surgery was out of network, leaving the patient with a $6,000 bill.

"This could have been any hospital, any day in the U.S., and it probably happens more frequently than we know, because patients usually don't complain," said Wheatley. "I think there's a lot of silent sufferers out there put in financial jeopardy because of the current state of the medical system, who need to speak out."

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