Monday, July 23, 2012

“Go Ask Your Doctor…” – Educating Patients and Physicians About Costs of Care

Christopher Moriates, MD is a Clinical Instructor in the Division of Hospital Medicine at the University of California San Francisco (UCSF). During residency training he co-created a cost awareness curriculum for residents at UCSF and is an active member of the American College of Physicians (ACP) High-Value, Cost-Conscious Care Curriculum Development Committee. 

The New York Times said that I probably should skip my annual physical. The other day, Consumer Reports sent me something in the mail entitled, “Imaging tests for lower-back pain: Why you probably don’t need them.” It said that imaging is “often a waste of money” and raised concern about cancer resulting from the radiation. They also published an article subtitled “Learn when to say ‘Whoa!’ to your doctor.” The ABIM Foundation’s widely publicized “Choosing Wisely” campaign popularizes lists of various practices that “physicians and patients should question.”

Instead of “Go ask your doctor if Cialis is right for you,” may we actually start to see patients asking their doctor if they really need that test or procedure? Will patients themselves help curb health care waste? Well, you may say that I’m a dreamer, but I’m not the only one.

If you are a physician, you probably should be thinking about how the heck you are going to appropriately field these questions, while crossing your fingers that the patient doesn’t actually go so far as to ask you how much that medication or test is going to cost them (the illustration of the doctor taking a stab in the dark is just about right).

After all, this was likely never even on the radar during your training. Admittedly, some prominent folks in medicine question whether it even should be, as nicely shown in this brand new, balanced article in the New England Journal of Medicine, which also highlights the Cost Awareness curriculum that we (Drs. Krishan Soni, Andrew Lai, Sumant Ranji, and myself) have developed here at UCSF, and the inspiring work of Dr. Neel Shah and the Costs of Care organization.

Given all of this, I strongly argue that it is becoming increasingly obvious at this point that physician education is going to be a key “necessary, but non-sufficient” initial intervention in approaching high value care.

I will reappropriate an analogy that Bob Wachter, UCSF Chief of the Division of Hospital Medicine (and my new boss), quoted to our group today about a slightly-different, but related situation (paraphrased): “The medical world has one foot in the boat and one foot on the dock and pretty soon is going to need to decide to jump in the boat. It is pretty clear where the boat is going.”

Enter the new AAIM-ACP High-Value, Cost-Conscious Care curriculum, which officially launched just days ago on July 10, 2012. Some of the resources, including the successful case-based format and take-away lessons, from our UCSF Cost Awareness curriculum, were adopted and adapted for this exciting new curriculum. This AAIM-ACP ten-module series is freely available to anyone interested (with the completion of a very short registration form) at

The curriculum, developed under the leadership of Dr. Daisy Smith from the ACP, by a committee including Internal Medicine program directors, faculty and residents from around the country, consists of ten one-hour interactive sessions (an overview of this curriculum is provided). The modules are organized around real-life inpatient and outpatient cases including estimates of hospital charges. It is meant to be flexible enough to fit into different resident structures, such as morning report, noon conference, post-clinic conferences, or academic half-days.

I encourage you to go check it out.

Go ask your Program Director or Chief Resident if the high value care curriculum is right for you.  


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