Doctors' Dilemma: Lower Costs, Please Patients, or Avoid Lawsuits?

Leigh Page, MS

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September 11, 2014

In This Article

Patients Want Treatment, Not Cost Restraints

The most well-crafted efforts to cut costs, however, seem to fall apart as soon as patients enter the picture. Many patients insist on a certain drug or therapy, and some doctors belatedly agree, even if it's inappropriate.

One obvious example is patients demanding antibiotics for minor ailments like sore throats. A 2013 study found that doctors prescribed antibiotics at 60% of patient visits for sore throats and 73% of visits for acute bronchitis.[5] The prescribing rate should be about 10% for sore throats and 0% for acute bronchitis, the study authors said.

Unnecessary use of antibiotics is widely cited because it has become a public health issue, driving up antibiotic resistance in the general population. But persuading a patient not to use antibiotics takes up valuable time in the exam room, and many physicians have to move on with their day.

"It takes longer to talk patients out of a low-value service than just to say, 'OK, whatever, here you go,'" Dr. Tilburt said. "The standard 15-minute visit is too short to have a full discussion."

This era of patient-centered care has put further strains on the 15-minute visit. Patients now can thoroughly research their ailments on the Internet. This can make it easier for doctors to explain complicated medical issues, but it also makes it harder to deal with patients who think they are right. "Physicians now have to explain why the patient's research is not relevant to their case," said Chris Porter, MD, a general surgeon in Richmond, Virginia.

Patients are also bombarded by TV ads for drugs, and even ads from their local hospital, touting a new medical technology. "Surgery patients want the newest techniques," Dr. Porter said. "They'll say, 'I want my colon taken out laparoscopically early on.'"

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