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Using Bedside Stories to Unmuddy the Waters


Last year, the nonprofit that I direct launched an unusual essay contest—we asked doctors and other care providers to tell us about their mistakes, including times they made decisions that inadvertently led to unaffordable medical bills. We also asked patients to share stories about their struggles with lack of price transparency in the system. Ultimately, we collected more than 100 stories from patients and care providers across the nation that illustrated the importance of cost-awareness in medicine, and then made these stories part of the public discourse by widely sharing them. The stories generated an impassioned response in the national media, and showed how transparency helps patients financially plan for their care, and also helps doctors keep medical bills affordable.

However we also learned that knowing what tests and treatments cost is only the first step. Then, you have to know what to do with that information, and using cost information at the bedside can be both ethically and pragmatically challenging. How do you determine which tests are not only affordable, but of high value? How can cost-consideration be reconciled with our ingrained ethos to do everything possible? How do you fit the time and effort that cost-consideration requires into a busy clinical workflow? How do you apply decisions to conserve resources in a way that is equitable to all patients?

As a result, we’re doing the contest again. For the second annual Costs Of Care Essay Contest we are not only asking for stories about unexpected medical bills or difficulty figuring out medical costs, but also asking for positive stories about ways doctors and patients have figured out to save money, while still delivering high value care. To help judge the submissions we recruited incoming Harvard University Provost and health economist Alan Garber, along with former White House Budget Director Peter Orzsag, Surgeon General C. Everett Koop, and others. $4000 in prizes will be offered, $2000 of which will be reserved for medical students and other care providers.

The evidence says that there are ample opportunities to save money in our routine decision-making without compromising quality of care. A recent survey from the management company Bain & Co., indicates that as many as 80% of physicians believe bringing healthcare costs under control is part of their responsibility. The Physician Charter states that avoiding unnecessary tests and providing cost-effective care is part of our professional obligation. However, despite the opportunities to save and wide-recognition of its importance, cost-consideration has yet to penetrate clinical practice.

Ultimately, it will be up to a new generation of physician-leaders to carry this charge. Are we up to the challenge? The evidence is clear but sometimes a good story can be worth 1000 academic papers to catalyze change. If you have one, we would love to hear it. Submissions to the 2011 Costs of Care Essay Contest should be no longer than 750 words, and should be e-mailed to by November 15th.

Neel Shah, M.D., M.P.P. is the Executive Director of and a senior resident in the Massachusetts General Hospital-Brigham & Women’s Hospital combined residency in Obstetrics and Gynecology.

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