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Asking patients about their health care financial concerns

by Libertad <http://www.kevinmd.com/blog/post-author/libertad-flores>

| in Patient <http://www.kevinmd.com/blog/category/patient> | no responses

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I remember joking with Dad about how he’d outlive us all. He had gone

vegetarian 10 years before I was born, never smoked, took vitamins, and

asked for a designated driver after his annual Heineken at the neighbor’s

Christmas shin-dig. He flossed, wore a seat belt, and looked forward to

annual physicals. If I tried leaving our Michigan house in the winter with

more than 3 inches of skin exposed, he would follow me to the door yelling,

“It’s no fun being sick!”

We were always working class, but both my parents had union jobs with solid

benefits and therefore we were covered by two health plans. Despite our

attempts at persuasion, he refused to drop his coverage–the Rolls Royce of

health plans, as we dubbed it–in favor of my mother’s plan. “I don’t want to

worry about bills” he said, and only dug his heels in after retiring.

Nevertheless, on his 64th birthday my father had an endoscopy, after which

the physician looked stricken. Later I saw images of the adenocarcinoma that

spread like a hand around the top of his stomach and into his liver. He was

supposed to have 3 months without treatment, but things were looking up

after a few rounds of chemotherapy. He was tolerating the treatment well,

and the spots on his liver shrank. Thank God he stuck to his guns about the

insurance, I thought. It was one less thing to worry about.

Just after Christmas, my father caught a minor infection but was

hospitalized for a week. Listening outside the curtain in the emergency room

as he had a Foley inserted was a low point, but I did not know then about

the insults left to come. He pulled through, but decided to stop

chemotherapy the following month. Around March, Mom mentioned that

collections notices had started coming to the house, and that dad had tried

to hide them. I wanted to help, but she had no idea what the bills were for,

and couldn’t understand how there could be a bill when we had two good

health plans. Mostly what I gleaned was that she was scared. She was trying

to get him to his appointments on time, make sure he took his medications,

feed him and generally cheer him on. I remember ending these calls with a

pit in my stomach about where this could lead, but we had to prioritize. One

crisis at a time, my mother would say.

The woman unflinchingly emptied buckets, changed diapers and slept in a

folding chair next to my father toward the end, but she was not built for

the business aspects of illness. So in the week following Dad’s death I

called the insurances, the hospital, and the collectors to let straighten

out the mess. Despite having wading through those bills, I still could not

say what his treatments cost. As to what they were worth, there are still no

words.

I used to wonder what went wrong, or what I would advise others to do to

avoid this kind of stress, short of never getting sick. I have only

gratitude for the doctors with regard to his treatment, and for the

manufacturers of the treatments that extended his life. But how exactly do

you put a price on these that still give allows patients access? Quality

costs, and I do not envy the people charged with that task. Should health

care providers routinely ask patients about their financial concerns as it

relates to care? In our case, when I think of my sick father hiding away

bills, I don’t think it would have hurt. I am left with hope, but no answers

for the millions without coverage. What should they do? When I am a

physician, what can I do?

Libertad is a medical student.

via kevinmd.com <

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