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G. Caleb Alexander, MD, MS; Lawrence P. Casalino, MD, PhD; David O. Meltzer, MD, PhD

Arch Intern Med. 2005;165:633-636.

Background  Physicians often do not communicate with patients about out-of-pocket costs, although research indicates that physicians and patients value such discussion.

Methods  Cross-sectional national random sample mail survey of 1400 cardiologists and general internists to quantify barriers to communication about out-of-pocket costs and strategies used to assist patients in order of likelihood (from 5 [extremely likely] to 1 [not at all likely]).

Results  Overall, 519 (39.1%) of 1328 eligible physicians responded to the survey. The most common barriers were lack of habit, insufficient time, and concern over patient discomfort. The most common strategies used to assist patients were switching to a generic drug (mean, 4.34; SD, 0.86), using office samples (mean, 4.16; SD, 1.22), and discontinuing nonessential medicines (mean, 4.03; SD, 0.99). There were no statistically significant differences between cardiologists and general internists in barriers or strategies examined (P<.05).

Conclusions  Our findings suggest that patient-physician communication about out-of-pocket costs is a problem affecting specialists and generalists nationwide. Despite barriers, physicians use multiple strategies that may vary in efficacy to assist patients burdened by these costs.

Author Affiliations: Robert Wood Johnson Clinical Scholars Program (Drs Alexander, Casalino, and Meltzer), MacLean Center for Medical Ethics (Dr Alexander), Department of Health Studies (Dr Casalino), and Harris School of Public Policy (Dr Meltzer), The University of Chicago, Chicago, Ill.

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