Home » News » Money Changes Physician-Patient Relationship

Money Changes Physician-Patient Relationship

Money Changes Physician-Patient Relationship As medical costs escalate employers and insurers are requiring individuals to pay more of the bill with increased deductibles and out of pocket co-pays.

This new consumerism may call for physicians to talk to patients about money, according to researchers at Wake Forest University School of Medicine.

Requiring individuals to shoulder more of the financial burden of medical costs could change the way physicians practice medicine as expensive treatment options may be unaffordable even if the treatment may be the best approach.

“Each year, doctors are finding more and more that patients are coming in carrying substantial deductibles and having to pay more out of pocket,” said Mark A. Hall, J.D., a professor of law and public health in the Division of Public Health Sciences at the School of Medicine.

Co-authored by Carl E. Schneider, J.D., of the University of Michigan at Ann Arbor, a summary of three years’ worth of research on the subject, appears in the current issue of the Journal of Family Practice.

Hall said that doctors generally avoid asking patients about health insurance and finances because physicians want what they believe is best for their patients – and what’s best might not always be most affordable.

However, Hall and Schneider say patients are counting on physicians to help guide them to the best treatment decisions – medically and financially.

The researchers reviewed literature on relevant professional ethics and interviewed primary care physicians who treat lower-income patients to see how the physician-patient relationship is changed by the current trend in consumer-driven health care – in which patients pay for more treatment themselves and therefore make more cost-related choices.

The physicians described patients who left prescriptions unfilled or refused to get diagnostic treatments because they couldn’t afford them. One patient severed a finger in a farming accident, and his primary care physician fixed it – though he knew a surgeon at a hospital could better ensure limited nerve damage. The patient said he wanted his doctor to treat him – or would receive no treatment at all.

Hall encouraged patients to bring up financial concerns with their doctors.

“You shouldn’t be afraid to talk to doctors about having to pay for things,” he said, adding that doctors and patients talking about money is not a new concept. Doctors several generations ago, before employer-sponsored health insurance was standard, hashed out payment with patients daily, he said.

“We have forgotten that aspect of professional folk wisdom,” Hall said. “Doctors need to make their treatment recommendations in the context of what patients can and can’t afford, with the understanding that some patients can’t afford what they might recommend.”

Hall said doctors need training on how to effectively talk with patients about money. The experienced physicians interviewed for this study suggested asking patients not about ability to pay, but instead about the extent of the patient’s insurance coverage, to avoid the embarrassment some patients feel admitting they can’t afford their doctors’ bills.

“Normalizing with tone of voice and a matter-of-fact way, the patient picks up that this is not something embarrassing,” Hall said. “This is just a fact that the doctor wants to know about.”

Moreover, malpractice is of little concern. In previous studies, Hall and Schneider found that such conversations – and the treatment decisions they result in – created negligible legal issues for doctors.

“If they have an open conversation with a patient who subsequently chooses to take a cheaper route, there’s little chance of a lawsuit because the choice is ultimately for the patient, not the doctor, to make,” Hall said.

Source: Wake Forest University Baptist Medical Center

Money Changes Physician-Patient Relationship

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2018). Money Changes Physician-Patient Relationship. Psych Central. Retrieved on March 25, 2019, from
Scientifically Reviewed
Last updated: 8 Aug 2018
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
Published on Psych All rights reserved.