The Medical Professionalism Blog

Maybe the awareness of cost and effective decision-making in health care will be propelled by the next generation of physicians and clinicians. After all, it was the American Medical Student Association that propelled the conflict-of-interest “movement” by grading their academic medical centers’ conflicts of interest with the pharmaceutical and device companies. The generation now in medical training, deeply concerned about their children’s education, smartly looks at waste in health care spending as diverting investment from that in their children’s education. Aren’t these house staff members and students the ones that see unnecessary care performed by their attendees and question what another test or procedure will add to the outcome of a patient?

I recently met a resident on a mission, Neel Shah, with an interesting story. He was a medical student at Brown who took a leave of absence to attend the Harvard School of Government because of his concern about the cost of care and other structural deficiencies in the health care system. He returned to finish medical school and is now a third year OB-GYN resident at Brigham and Women’s Hospital and Massachusetts General Hospital.

Neel is an inspiring person. He has the courage to act boldly on his deep-seated convictions and values. One leaves a conversation with him over dinner in complete admiration and respect for what he is trying accomplish.

Neel started a non-profit organization called Costs of Care whose mission is “to help doctors understand how the decisions they make impact what patients pay for care.” The organization’s website notes: “Medical bills are now the number one cause of personal bankruptcy in the US (2005 Harvard study).” A chilling fact, but all too true.

One of the first initiatives of Costs of Care was to sponsor an essay contest for trainees, physicians and patients. Judges for this year’s contest just underway include:

• Peter Orzsag
• Dr. C. Everett Koop
• Hon. Jennifer Granholm (former governor of Michigan).

The categories of the stories and the prizes tell a lot about this “from the bottom up” movement:

- A patient story that describes how cost-awareness lead to high value care or cost saving

- A health provider story that describes how cost-awareness lead to high value care or cost saving

- A patient story that describes how lack of cost-awareness lead to an unexpectedly high bill, or difficulty figuring out how much a test or treatment would cost

- A health provider story that describes how lack of cost-awareness lead to an unexpectedly high bill, or difficulty figuring out how much a test or treatment would cost

Besides this, Costs of Care (through a grant from the ABIM Foundation) is developing videos and didactic curricula aimed at teaching trainees how to improve healthcare value through bedside clinical decisions.

It’s definitely the beginning of something; grassroots movements have real power. It now needs academic medical centers and faculty to support and model behavior for these goals to succeed.