Patients want to talk specifics about options, costs of care

Studies show patients are asking for certain procedures and want to discuss money.

By Damon Adams, AMNews staff. Sept. 15, 2003.

Two new studies show that patients are making greater demands of physicians, asking doctors for specific clinical services and wanting them to talk about out-of-pocket costs for care.

A study of patient visits to doctors in California found that about one in four patients requested a diagnostic test, specialty referral or new prescription drug. The chances of receiving services were better for patients who made requests than for those who didn't, according to the study published in the July 28 issue of the Archives of Internal Medicine.

A different study reported that two-thirds of patients want to talk about out-of-pocket costs, such as co-payments. But the study in the Aug. 20 issue of the Journal of the American Medical Association found that about one in three physicians discussed such costs with patients.

Physicians said the studies highlight the increasing role of patients in decision-making and the need for doctors to focus more on patient-physician communication.

"The patient as partner is a cow that is already out of the barn. Physicians who look to resist the trend probably have a feudal fight on their hands," said Richard L. Kravitz, MD, MSPH, professor and director of the Center for Health Services Research in Primary Care, University of California, Davis.

Dr. Kravitz was lead author of the study on patient requests, titled "Direct Observation of Requests for Clinical Services in Office Practice," which appeared in the Archives of Internal Medicine. Researchers audiotaped 559 patient visits to 45 doctors in two health care systems in California in 1999. They then tallied requests made by patients for services.