Not discussing the costs of medical interventions could result in “financial toxicity” for patients who have trouble paying out-of-pocket costs, as well as problems adhering to expensive treatment regimens. “The problem is perhaps starkest in cancer care, but it applies to all complex illness,” noted a recent article in The New England Journal of Medicine.1
Uncomfortable Discussion
Among the challenges to a frank discussion of costs, according to the article, “patients and physicians face social barriers in discussing costs of care. No doubt, many doctors and patients find discussions of money uncomfortable; they have not been coached in having that discussion.”
The way you talk about money, advised the article’s lead author, Peter A. Ubel, MD, in an interview with The ASCO Post, “is the way you talk about any cost or benefit of treatment. And you need to make sure that patients understand you are not judging their value as a person or assuming anything about their financial situation.”
As an example, he offered this approach to the conversation: “I know that some of my patients have been stressed out and burdened by the cost of medical care. I want to make sure to talk to you about treatment costs before you get burdened.” Dr. Ubel is Professor of Business, Public Policy, and Medicine at Duke University, Durham, North Carolina.
Patients Taking the Lead
In a follow-up op-ed piece in The New York Times,2 Dr. Ubel added that “patients should not be afraid to take the lead and ask how much a pill or procedure will cost.” That is happening already, he said.
He has begun a study on that issue and said that while “I don’t have precise data on it yet, I can tell you my early study of this shows that patients probably bring up costs at least as often as physicians and probably more often, although typically it is to complain about costs they have already incurred.” ■
Disclosure: Dr. Ubel reported no potential conflicts of interest.
References
1. Ubel PA, Abernathy AP, Zafar SY: Full disclosure—out-of-pocket costs as side effects. N Engl J Med 369:1484-1486, 2013.
2. Ubel PA: Doctor, first tell me what it costs. New York Times. November 3, 2013.
