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What doctors and patients can learn from accountants and veterinarians



Dr. Diane Tang, of Mohawk Alley Animal Hospital, examines Melvin.
Dr. Diane Tang, of Mohawk Alley Animal Hospital, examines Melvin.
Rebecca Plevin/KPCC

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Here at Impatient, we've been exploring why doctors and patients don't often discuss the costs of health care. I've also been offering tips on how both can play a role in making these conversations a part of routine care.

But this concept of discussing costs in the exam room is still foreign to a lot of people. So today, for a radio story that's airing on KPCC, I provide examples of situations where these types of cost-related discussions occur more frequently.

'A great investment'

My search for models for better conversations about health costs brought me to the Hollywood office of accountant Persida Matei.

She says she asks her clients a lot of questions when she first starts working with them. Questions, she says, like, "are you married? Do you have children? What is your age? What is your tolerance to risk?"

She says she would never offer investment advice without first understanding her client's short- and long-term goals. She explains: "It may be a great investment, but not a great investment for them. And then you've done them a disservice."

What can we learn from Matei's interactions with her clients?

For one, it's important that doctors know if a patient is on a high-deductible health plan, and is digging deep into her own pocket to pay for recommended procedures and medications. As I've reported, a doctor might then tailor any recommendations to the patient's specific needs.

Dr. Peter Ubel, a physician who studies health care costs, is a big advocate for these types of discussions.

"I used to tell my patients, 'look, I'm the expert on the medical facts, but you're the expert on you,'" Ubel says. "And so I need to understand you better, to help you figure out what's best."

Melvin as a model

My next stop for this story was Mohawk Alley Animal Hospital, where I met veterinarian Dr. Diane Tang. She was checking out a suspicious bump in the mouth of a cat named Melvin.

After a thorough examination, she tells Melvin's mom, Morgan Bradley that there are several possible treatment routes. Then Tang's assistant gives Bradley an estimate for how much each option would cost.

Bradley says she appreciates getting this information upfront. "It always helps in knowing what to prepare for and how much money I'm going to have to scrounge for," Bradley says.

If veterinarians discuss treatment options and cost all the time, why can't we do that for human health care?

Dr. Reshma Gupta, an internal medicine physician at UCLA, says the veterinarian model is a good one for our health care system, but there's a caveat.

She says doctors and patients can - and should - discuss different treatment options, just as veterinarians do. The problem, she says, is doctors have no way of knowing what those options will cost. The reasons are complicated, but they break down to this: Doctors don't know what an insurance company will pay for a drug or procedure, and they don't know how much of the cost will be passed on to the patient.

Doctors, "do not have access to costs of medications, or commonly ordered labs, or radiology when they're face to face with a patient," says Gupta, who also works with the nonprofit group Costs of Care.

"And so they don't have the ability to actually offer that information to patients, and I think that's something that really needs to be addressed in the future," she adds.

Do these examples resonate with you? Can you think of other situations where people do a better job of talking about health care costs, and could they be models for the doctor’s office? Let me know in the comments section below, or shoot an e-mail to Impatient@scpr.org.