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Stop blaming “demanding patients” for driving up health care costs

A recent JAMA Oncology paper by Dr. Ezekiel Emanuel and colleagues from the University of Pennsylvania, “Patient Demands and Requests for Cancer Tests and Treatments,” is worth a look.

The authors note that:

“Surveyed physicians tend to place responsibility for high medical costs more on “demanding patients” than themselves. However, there are few data about the frequency of demanding patients, clinical appropriateness of their demands, and clinicians’ compliance with them.”

But in their analysis of more than 5,000 patient-clinician encounters in oncology outpatient facilities at 3 Philadelphia, area hospitals, the authors conclude:

“Patient demands occur in 9% of patient-clinician encounters in the outpatient oncology setting. Clinicians deem most demands or requests as clinically appropriate. Clinically inappropriate demands occur in 1% of encounters, and clinicians comply with very few. At least in oncology, “demanding patients” seem infrequent and may not account for a significant proportion of costs.”

There was surprisingly little mainstream news media coverage of this paper.  HealthDay and Bloomberg were two of the few news organizations I saw that reported on it.

The Bloomberg story added some interesting angles.  Excerpts:

“…dealing with patients who inform themselves about their conditions online has changed the usual medical relationship, according to Anthony Back, a cancer specialist at the Seattle Cancer Care Alliance.

“A lot doctors view this negatively as in, ‘If only those patients didn’t have this information my job would be simpler,’” Back, who wrote an editorial accompanying the new study, said in a phone interview. “We have to stop blaming patients about this. It’s not true from this data and it’s not helpful in terms of how do we move forward.”

“When a patient makes a request it’s somewhat of a vote of no confidence,” Emanuel said. “That makes them feel bad and I think that’s why docs perceive them as a lot more common than they really are.”

One patient asked unsuccessfully for proton-beam therapy, and there were also requests deemed inappropriate for chemotherapy agents and surgeries. Proton-beam therapy, which involves machines that can cost $100 million to $150 million to install, hasn’t been shown conclusively to be more effective than comparable treatments.”

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