Money & Medicine

How to Be an Activist in the Doctor’s Office

Volume CVIII, No. 6June, 2008

Martha Hyde

You are sitting in your doctor’s office. He or she is ready to prescribe a medication for you. You wonder how much the drug will cost you. The doctor may be ordering a procedure, an MRI or a series of blood tests. You may be wondering if these procedures will be covered by your insurance or if they are even necessary.

Most of us would not hesitate to ask, for example, for a car repair job to be done more simply or for a cheaper part if we think it will solve our problem and save us money.

Unlike car repair, most people regard access to medical care to be vital. However, it is not guaranteed to anyone in the United States until age 65, and then access may be limited.

Unlike car repair, health care does not follow the simple economic rule of supply and demand.

Unlike car repair, there seems to be a mental barrier to asking what something will cost when you are seeking health care. The implication is, “Why would you ask such a question if you really need the care?”

Health care spending in the U.S. climbed to over $2 trillion in 2006 and accounted for 16 percent of GNP, according to the U.S. Centers for Medicare and Medicaid. An annual health care inflation rate of 6 percent is widely considered to be typical. That is roughly twice the average overall inflation rate. It is also two to three times higher than the average rise in workers’ wages for four out of the last five years.

We spend almost twice as much for health care in the U.S. than in Europe, yet medical outcomes and patient satisfaction are no better here; indeed they are arguably worse.

It is increasingly clear that spending a lot of money does not necessarily lead to better results, and that normal economic law does not control health care costs.

Cesarean section births, which cost more than vaginal births and require longer recovery periods, are almost twice as common in the U.S. as in the Netherlands, yet maternal and infant mortality rates are worse here.

Researchers at the Dartmouth Medical School found that spending on Medicare patients in the last six months of their lives was driven by the prevalence of specialists, such as oncologists and cardiologists, and the concentration of cutting edge technology, like MRI’s in certain regions. More supply led to more demand, turning basic economic orthodoxy on its head. The outcomes and patient satisfaction were no better in the higher-spending regions than in the lower-spending regions.

Research has also shown that poor communication between doctors, poor doctor/patient communication and lack of accessible records also lead to higher costs and worse outcomes, not to mention medical errors.

Drug companies often aggressively market new products that have been approved by an overwhelmed — and often compliant — FDA, but that have not been adequately tested. The companies themselves often fund further clinical trials on their products after they are on the market, but then fail to release negative results of those trials in a timely fashion, putting the public at risk.

So here you are in your doctor’s office. What should you do? First, remember that YOU are the client. You have the right and responsibility to ask for what you think you may need and to question any treatment you think you may not need.

As I’ve written above, some procedures may be ordered or prescriptions written based on easy availability — not on necessity. So you should feel empowered to question the need for them, especially if they sound painful or expensive.

On the other hand, if you have pain or symptoms that are not being addressed adequately, ask for attention to those things. If you are too ill to do this for yourself, try to find someone to act as your advocate. Communication is vitally important, between you and your doctor and also between your doctors, especially if you are being seen by several specialists. If you are being treated by more than one doctor it is likely they are not communicating very well with one another.

Second, remember that doctors generally are poor fiduciaries. They are thinking about your medical welfare, not your finances, and they are also thinking about their own convenience and what methods and drugs they have easy access to. It is all right to request generic prescription drugs, particularly in light of the fact that the latest brand-name drugs are usually expensive and may not be well tested.

It is all right to insist that lab work or X-rays be done in your network, whether it be MagnaCare or another. If you are in an HMO, you will need to find out if all procedures being ordered and all specialists treating you are in the network, or you may end being surprised by extremely high bills after all is said and done.

You are the one who has to live with the outcome, both medical and financial, and the system generally runs on a “buyer beware” ethic.

There are many people who would like to see this change, but that is a subject for a different article. Until we can change it we have to live with it.

This kind of activist approach to one’s own health care can seem intimidating or burdensome. Some people may worry about alienating their doctors, while others may resent having to take on part of the responsibility for their own care when so much money is being paid for these services.

It may be helpful to remember that if you do not ask for something, you probably will not get it. Remember that most doctors are human, and are interested in patient satisfaction. If you find a way to ask for what you want without sounding accusatory or demanding, you will likely find them agreeable.

I have also found in my own experience that having a say and some measure of control over my own health care leads to better financial, medical and emotional outcomes. As individuals, there is so much we have no control over; we should assert control where we can.

Martha Hyde is a multi-woodwind player who performs on Broadway. A member of Local 802, she is also a trustee on the Local 802 Health Benefits Fund. E-mail her at