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Beyond 7 minutes

I trained as a Family Doctor so that I would be ready to help patients with any challenge. The old school family doc used to take that skill set out into the community on house calls, sports sidelines, and town hall meetings. At some point the job description was boiled down into a job that started and ended with a 7 minute office visit. That setup is not good for patients, and it's not good for doctors. In this column I hope to start to push the boundary of where the doctor patient interaction takes place - onto the page, into the community, and beyond 7 minutes.

Financial Harms

A doctor's oath is first, to do no harm. That has traditionally been interpreted to apply to in the office, to the prescription pad, and under the knife. Yet everyday patients are leaving appointments only to face astronomical medical bills, high insurance prices, and crazy prescription drug prices that are harming them financially. Although doctors do not set these prices directly, they are still the integral link between diagnosis and treatment. I firmly believe these are good people in a bad system. However every clinician is complicit in this system. It could not go on without us. I believe we have an imperative to help fix it.

For too long doctors have been blinded to the price of care. We have become so far removed from the economics of medicine that we have neither the awareness or agency to control costs. The economic transaction of paying for care often take place weeks to months after the care in question by people who ultimately had nothing to do with it. This disconnect leads to frustration on all sides.

There is interesting work happening at a legislative level to increase price transparency of medical procedures. Maine passed the right to shop law in 2017, which encouraged doctors to give patients choices in where to receive care. It also incentivized insurance companies to reward patients for making smart choices. The accessibility of Health Savings Accounts (HSAs) helps consumers feel like they have some choice in where their health care dollars go. Despite this progress over the last year, many patients are still finding that medical care is unaffordable.

On a broader scale in January of 2019 Federal rules mandated that hospitals make available prices for the services they offer on their website. The website comparemaine.org is also a new resource utilizing this data for cost comparison. The idea is that by printing prices consumers will be able to make more informed decisions about where they choose to receive care.

Simply listing prices does not appear to have encouraged competition. When I browsed the lists from 2 local hospitals I found a common office procedure, removal of benign skin moles, cost $70 and $170 at another facility. Since this is such a common procedure, often done is a primary care office, it's doubtful that many consumers would spend the time to shop around before having this done.

Health Care will always cost money. What we need to work towards are reasonable prices for health care that helps people. If we acknowledge that financial well being can and should be under the purview of the providers recommending the medicine it allows an alliance between doctors and patient to try and restore sanity to a broken system. These are good people. Let’s work to create a good system.

A version of this story was published in the West End News 4/5/19

http://thewestendnews.com/do-no-financial-harm/


Oren Gersten, MD