By Anonymous, MD
I remember being a New York City public school teacher, prior to medical school, and buying my own supplies for my classroom. I did not realize I would apply similar budget saving skills to treating my patients. Every Friday morning, I would look forward to going to my primary clinic at the VA. I was delighted to treat my veteran patients. I would also look forward to the personal stories they would tell me which ranged from war stories to updates on their grandchildren. Their stories were often unrelated to health care but it was the essence of what made my primary care visits personalized.
As a resident physician, I was often shielded from the costs of care. This was a general trend, throughout training, from medical school to fellowship. In medical school, I did not receive any formal training in finance; however, it would have been beneficial from a professional perspective. Professionally, I took an oath to “do no harm” which I strive to uphold but what about the “financial harm” that I may inadvertently subject my patients to. I would only become aware of the costs of care, after the fact, when my patients would educate me on the, often times, exorbitant costs of their medications. It was often unclear to me how much my patients were paying for their medications and my services. Asking patients, can they afford their medications did not occur to me.
Being a resident physician at a major academic center in the Midwestern city, surrounded by skyscrapers and luxury condos, one does not always put costs in the forefront of the patient encounter. I did not understand how important this was, until one day, when I was seeing one of my primary care patients. I was reviewing his medications with him. My patient said he was not taking his medications but he was evasive as to why? I began to probe a little more stating, “you really need these medications to protect your heart” because of your coronary artery disease. I thought educating him on why he needed the medications was going to convince him to take the medications. Finally, he said “Doc” I am retired and I have to pay an $8 dollar co-pay for each of the medications. A prescription for ten medications costs $80 a month and nearly a $1000 annually. In my leisurely shopping, I recalled seeing major retailers advertise a $4 prescription list for common generic medications.
Just like a stethoscope was an essential tool for my weekly primary care clinic, carrying my $4 prescription pamphlet became an essential tool as well. Part of my routine, along with a thorough history and physical exam, was to set aside 5 minutes to perform my individual cost analysis of prescription medications for each of my primary care patients. My cost analysis consisted of asking the patients how much their co-pay fee was and then, I would review their prescriptions and figure out which medications I could substitute with generic equivalents from the $4 list to save money. I had my calculator and a prescription pad so that my patients could get their prescription filled at any retailer they desired. My patients were often grateful and they liked seeing the dollar amount they were going to save.
Veterans will always have a special place in my heart because of the service they performed for our country. To think that they served our country and still had to face difficult choices like opting not to pay for medications, because they were too expensive, was heart-breaking. I remembered when I was a public school teacher; I would buy my own supplies because I did not have the necessary supplies to teach including paper, chalk, and pencils. Although my pay was minimal, I would create a budget each month and look for the best bargains which helped me minimize my costs. In a similar fashion, I began to perform individual cost analysis for each patient and it became a regular component of my weekly primary care clinic visit.