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Oncologists comfy talking sex, death… but not costs

Posted Jun 18 2010 12:29pm

I highly recommend reading Delivering the “New Bad News”: Discussing Costs With Patients by Roxanne Nelson on Medscape Today. The article reports on an ASCO sessions that dealt frankly with the challenges oncologists face in discussing financial issues with patients.

“[A]s physicians, we have mixed loyalties; we are drivers of medical costs and, on the other hand, we are advocates for our patients,” [the moderator] said. “It’s kind of messy territory for us.”

Patients might be embarrassed to discuss their finances with their physician and fear that it will affect treatment decisions, she continued. There are also time constraints.

“It may be very difficult to have this discussion in the context of an often busy and very rushed medical practice,” Dr. Schapira noted. “Let’s face it, patients may be unwilling to mention their cost concerns because they don’t want you to recommend anything except what you think is best for them.”

Finally, patients may feel that physicians “don’t have a clue about this sometimes,” she said. “If the doctor is not going to be able to solve the problem, they probably have learned from experience that they’re not very interested or keen in talking about it. We’ve seen the same evolution in other topics that physicians often find difficult to talk about.”

The fact is, finances already play a role in cancer care, whether the oncologist wants to discuss it or not. Certainly oncologists have been making decisions for a long time that enhance their own incomes. Second, even if there’s no discussion many patients a mas about care partly determined by cost. And even for those that aren’t financial stresses play into their well-being and resilience.

The more oncologists and other physicians get comfortable talking with patients about costs the better. One thing that will help is robust comparative effectiveness research so that decisions are based on evidence, not just marketing hype.

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