No, really, it’s not our fault. According to a study published last month by JAMA Oncol, it is a myth that escalating health costs are driven by patients “demanding” tests and treatments. It simply is not happening. Rather, it would appear that responsibility for factors ranging from poor communication, to “defensive medicine”, to deliberate overpricing of various tests, procedures and medications, to manipulation and gouging by “big pharma” and outrageously high medical malpractice premiums that providers must cope with, must be passed on somehow. And like cancer treatment itself, it’s cumulative. But in spite of all that, no, no indeed, it is not the patient’s fault!
The JAMA Oncol investigation reports that in a study of over 5,000 patients with various cancers, including some of the most severe, less than one in ten (8.7%) asked for a particular treatment or intervention, and providers complied with most of these (83%), finding them clinically appropriate. Of the few that were found to be inappropriate, only seven (0.14%) were indulged. This is not a significant driver of costs. If this is true in oncology, where the patient stress level is very high and demands for anything and everything would be expected, it’s even less likely for less severe conditions.
Point two; it’s not the Internet’s fault either. Despite reports from some providers that the ease with which patients can obtain information about their condition and treatment options, is driving demand for excessive and expensive tests, procedures, etc. But this is another myth. And this myth is very confusing to patients, as we are constantly encouraged to bring lists of our concerns with us to appointments. We are told to come to appointments prepared to make the most of the short time we have with our providers. We are told that an informed patient “chooses wisely” and questions the need for extra tests and treatments but we are then blamed for doing our diligence, our lack of understanding what we are asking for and about, and for driving up the costs of care.
The fact is, that no matter how informed, misinformed, demanding or compliant a patient may be, we are still in your CARE. Unless we have a medical degree ourselves (and in the appropriate specialty, no less), we are always in a subordinate and vulnerable position. So you need to explain things and take our concerns seriously, not interpret them as threats. We want to be treated as individuals who deserve to have a respectful relationship with the person who helps us get healthy. Creating a collaborative relationship with patients will lower healthcare costs, not inflate them.