The Costs of Being a Patient and a Doctor

By Jane Liu

The cold ultrasound probe pressed uncomfortably onto my abdomen.  “It looks like an ovarian cyst,” the pleasant technician told me, “But of course we’ll run it by the radiologist.”  For the past few months, I had felt a dull, heavy pain in my right lower quadrant that sharpened when I coughed.  I’d put off having it checked during my busy schedule as a third year medical student.  However, the nagging knowledge of a strong family history of ovarian cancer finally pushed me to make an appointment.

The ultrasound was the first medical test I had undergone for a long time.  An emergency room trip for a severe sinus infection during my freshman year of college unexpectedly set me back $2,000.  Ever since then, I religiously avoided going to the doctor.  Even bilateral corneal scars from an eye infection treated a week late did not convince me to seek timely medical care.  I simply did not have the resources to handle the financial consequences.

The official read on my ultrasound came back “likely benign” with the recommendation that I follow-up in 6 weeks to be sure.  Over the next few weeks, I received one bill after another that totaled $1,000.  Stunned, I called the hospital to see if my insurance company could help.  It turned out that my insurance had already covered most of the $2,700 the procedure had cost; the remainder was my out-of-pocket expense.  The same hospital where I had spent months learning medicine and providing patient care was now making my own healthcare an unaffordable luxury.

Unable to pay, I felt abandoned by the system to which I had committed my career.  My only option was to ask the medical school’s financial aid office for an additional high-interest loan to cover the remaining cost.  On top of staggering tuition rates, it was disheartening to take out an additional loan for a simple, preventive, and supposedly inexpensive test.  When it came time for the 6-week follow-up, I did not call to schedule a second ultrasound.  Though my symptoms had persisted, I grimly reasoned that I could neither afford the test itself nor treatment for anything the test might reveal.

No other system in the United States leaves the consumer so blind to the cost of its service.   A medical bill can easily leave a family bankrupt, regardless of the quality or efficacy of the care received.  Cures may not be guaranteed in this practice, but at the very least, financial information regarding standard procedures should be made available to help patients decide which treatments or diagnostic tests to pursue.  On hospital rotations, I have seen mild diseases addressed by a slew of expensive diagnostic tests that ultimately yielded no diagnoses or treatment options.  If those patients had been informed of the likely costs of certain tests, they may have chosen to rest at home rather than stay in the hospital for weeks and suffer the bill.

Fortunately, there are leaders committed to lowering the cost of medical care for their patients and the community.  An attending physician on my internal medicine rotation handed our team a list of $4 prescriptions available at the local supermarket.  “Keep these in mind when choosing drugs,” he said.  Many drugs are sold at different prices depending on the dosage of a single pill, so a physician can choose to prescribe 60 5-mg pills for a month’s supply instead of 30 10-mg pills if the price is favorable.  I was amazed at how simple and useful this sheet was.  Monthly prescriptions are by no means the most complex of healthcare cost problems, but focused efforts can work towards additional tools to help healthcare providers lower costs for their patients.  As a patient and future physician, I hope that the development of such resources will yield immediate impacts to reduce healthcare costs, encourage preventive care, and restore confidence in the system.


Jane Liu is finishing her last year of medical school at Case Western  and was a contestant in the 2012 Costs of Care Essay Contest.

7 Comments on “The Costs of Being a Patient and a Doctor

Rosanne Karp, RN, ACM
October 28, 2013 at 3:48 pm

First of all, physician- heal thyself– you are not setting a good example of how to manage your own situation, knowing your family history. swcondly, this points out a huge gap in Medical education. Students need to learn the associated costs/risks of their treatment decisions and the impact in can have on care delivery. Ms Liu chose to forego followup because of the risk of incurring bills-not the safest choice around.
One other thing patients need to know- they can negotiate bill payment. It was not necessary for Ms Liu to go the college to request an additional loan. She could have called the billing office at the hospital and negotiated a reasonable payment program.Again- it’s all about education- both for the consumer and the povider!

Ali Khoshnevis, OD
October 28, 2013 at 3:49 pm

I commend Jane for writing this piece. I think it sheds light on a dark part of our healthcare system – the lack of price transparency.

It is simply not fair to specifically point out things that Jane could have done but rather look at this as a much larger problem. Knowing that you can negotiate the price of your hospital bill does not do enough. I believe if we are able to create a competitive, true free market enviroment in healthcare, we can effectively lower the cost of care. This may include policy changes in Washington or ambitious entrepreneurs to make it happen. Either way, it is a must.


October 28, 2013 at 3:53 pm

If she were cash pay then she could have negotiated the price down however the price she paid already includes any negotiation done by her insurance company. In fact it may even violate the hospitals agreement with the insurance company to take full payment from insurance and arbitrarily lowering the amount the patient pays. High deductible insurance plans encourage enrollees to pay for routine care while catastrophic costs are covered.

Sean Parnell
October 29, 2013 at 3:49 pm

Very well put. Negotiation is all good and well, but a better way is just to have transparent, up-front ‘package’ pricing. I keep being told it can’t be done, and then I see hospitals and surgery centers doing it which makes me thing the people saying it can’t be done don’t know what they’re talking about! Here’s one example:

And there are several more, especially once you get into medical tourism.

Sean Parnell
October 29, 2013 at 3:54 pm

That’s good to know that doctors are being given lists of which drugs are part of the $4 generic drug programs that just about every ‘big box’ store offers these days. There’ a whole world of affordable care options available to patients who have to pay some or all of their costs out of pocket, making sure that hospital-based doctors are aware of them would be a huge step in the right direction!

Air Commodore Dr HSR Arora
November 8, 2013 at 3:54 pm

Dear Jane Liu,
Excellent, commendable information. Every Hospital world over enhance the package of treatment higher by 15-25-35% which is mutually agreed by Hospitals Top management & Insurance Company . If we all do NANO TRACK THE COST OF PARTICULAR DISEASE Package based on ABC Analysis of the procedure you will be able to cut the cost by 30-45%.In all Insurance cases lot of things are added which are not even used. An advise to all the Indoor Patients the attender of patient has a role to play what ever is actually used for the patient to be listed in the hand book & compare with the bill at the time of Discharge. Every Hospital need to create a procedure kit for each procedure. See you put maximum generic items.
Air Commodore Dr HSR Arora
Sr Consultant Cardiac Rehabilitation & General Physician

Executive Travel Kimpton
February 12, 2014 at 3:54 pm

Wow, this piece off writing is fastidious, my younger sistdr is analyzing these kinds of things, thus I amm
going to tell her.


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