No, really, it's not our fault. According to a study published online on February 12, 2015, by JAMA Oncol, the Journal of the American Medical Association Oncological division, patients “demanding” tests and treatments as a driver of healthcare costs is a myth, an outright urban legend. It simply is not happening. Rather, it would appear that responsibility for factors ranging from poor communication, to “defensive medicine” (including provider insecurity at a number of levels), to deliberate overpricing of various tests, procedures and medications at every facility that a patient interacts with, to manipulation and gouging by “big pharma” and both patient medical insurance as well as the outrageously high medical malpractice premiums that providers must cope with, must be passed on somehow. And like oncological treatment itself, it's cumulative. But in spite of all that, no, no indeed, it is not the patient's fault!
The JAMA Oncol investigation reports that in a 9 month study of 5050 patients with various oncological diagnoses, including some of the most severe (read: desperate), only 440 (8.7%) asked for a particular treatment or intervention, of which providers complied with 365 (83%), as being clinically appropriate. Only 50 (11.4%) of those 440 requests were deemed inappropriate, and only 7, that's seven, were indulged. The final conclusion was that of the 5050 patients, only 7 or 0.14% of their requests were felt to be clinically inappropriate to their situation. This is not a significant driver of costs, even granting that those 7 requests were expensive due to the inherent nature of oncological treatment. If this presentation is true in oncology, where the patient stress level is very high, and demands for anything and everything would be expected, what about inappropriate patient demand in other spheres? Perhaps this needs further investigation.
Point two, it's not the Internet's fault either. Despite a sense out there among providers that the ease with which patients can obtain considerable amounts of information about their condition and it's treatment options being a driver of demand for excessive and expensive tests, procedures, etc., this is another myth. And perpetuating it is also confusing to the patient in general, as we are constantly encouraged to bring lists of our concerns with us to appointments, so as to make the short time we have with our providers the most productive, thereby saving calls and inquiries, and costs after the fact. We are told that an informed patient “chooses wisely” and questions the need for extra tests, etc., but we are then blamed for doing our diligence, our lack of understanding what we are asking for and about, and for driving up the costs of care. Not merely mythical, but contradictory (if not contraindicated).
The fact is, that no matter how informed, misinformed, demanding or compliant a patient may be, we are still in your CARE, and unless we have a medical degree ourselves (and in the appropriate specialty, no less), we are always and inherently in a subordinate and therefore vulnerable position, so you need to explain things and take our concerns seriously, not interpret them as threats. And before you swing too far in the direction of the paternalistic past, we don't want a shaman or a dictator either. We want to be treated as individuals who deserve to have a reasonable relationship with the person who helps us look after our bodies (including our minds!) at least as close as we have with our car mechanics. You may find that you have some good allies, and I submit that this will lower healthcare costs, not inflate them.