Excuse me while I second guess you, Doc

Excuse me while I second guess you, Doc

From the Wall Street Journal (Insurers Want Patients to Press Doctors About Drugs and Costs)

Lumenos Inc., a unit of health insurer WellPoint Inc., intends to start offering a service that lets its patients enter the names of drugs into their cellphone Web browsers, which in turn will shoot back a list of comparable drugs, ranked by how much they cost under Lumenos’s plans. That way, patients can ask their doctors about cheaper alternatives while they’re still at their appointment, the company says.

The scenario above sounds rude, and reminds me of an earlier post (Cell phone etiquette in the doctor’s office.) When health insurers think of consumer empowerment they tend to think of enlisting consumers in taking an adversarial role with physicians –just like the insurers themselves do. A better idea would be to help patients and physicians engage jointly in finding the most efficacious, cost-effective, and easy-to-tolerate regimen.

Some of the other approaches described in the article make more sense, including providing health statements with suggested questions for patients to ask their physicians.

January 31, 2006

4 thoughts on “Excuse me while I second guess you, Doc”

  1. While I agree that this is a poor way of handling the situation, it could potentially be quite beneficial for the patient to have access to cost information for medications while still at the MD. Do doctors REALLY enjoy dealing with the pharmacist fax that inevitably follows when the patient finds out how much the drug costs and declares that they can’t afford it?
    It doesn’t have as much to do with second-guessing as it does with making sure the patient gets SOME kind of therapy, even if it’s not the preferred option.

  2. I don’t see the ability to look up drug alternatives as being particularly “rude.” Having price and alternative choice information readily at hand would allow patients to be better health care consumers, to take a more active role, instead of just accepting what doctors, pharmaceutical manufacturers and insurance companies say at face value. Advocates of consumer-driven health care, or CDHC,(like Lumenos) assert that the lack of consumer choice in health care is partly to blame for the rising cost. By arming patients with such information, CDHC is helping them save money, with the long term goal of driving down costs by turning the health care industry into what most other industries are – competitive marketplaces.

  3. If a patient makes a cell phone call in the middle of an appointment with me, I will allow them one more call – to find another doctor. It is hard enough to address any patient’s specific concerns, much less review important preventative interventions during the average 10-20 minute appointment. To have a patient use their cellphone in the midst of a doctor-patient encounter is not acceptable.

    On another note – medications need to be selected based on a variety of considerations. Insurers focus on cost, but tend to ignore efficacy and safety concerns and are not equipped to consider drug-drug interactions. In addition, many physicians familiarize themselves with a limited number of medications. Repeated prescribing of a group of “trusted/known” meds likely reduces the chance of prescribing errors. Conversely, forcing physicians to prescribe a vast array of medications they are less familiar with (dictated by diverse formularies enforced by multiple insurers) likely increases the risk of prescribing errors.

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