Each week, authors at MedPage Today ask a handful of doctors about a health topic in a column called Friday Feedback. Last Friday they discussed the changing sentiment of the phrase “patient responsibility.” You can check out what the doctors had to say before diving into Dr. Silverman’s take below.
Old Phrase
Not long ago patient responsibility referred to the part of the medical bill the patient needs to pay directly (rather than the insurance company). Now patient responsibility means that patients need to take an active role in treating their condition. This is a unique twist on what had become a commonly used phrase in the medical billing office.
The term used to be thrown around the medical billing office when attempting to collect payment from a patient. When a person is simply unable to pay for their treatment, doctors are said to be “writing off the patient responsibility.” This year, with more people than ever before having very large deductibles, there has been a significant increase in patient responsibility.
New Meaning
As we mentioned above, patient responsibility has taken on a new meaning in the medical community. Patient responsibility also means that a patient needs to actively work to improve their condition, be it by eating right, sticking to their rehab, or adhering to doctor instructions. The vast majority of patients aren’t going to get better if they are just popping a pill and sitting on their couch eating pizza.
We believe patients should be very involved in their care. That said, I have never been the paternalistic doctor who tells the patient what to do at every turn. Instead, we provide patients with the same three choices and follow up discussions every time that they want to address a problem:
1. Live with it and do nothing (We also discuss the consequences of this choice).
2. Treat or manage it non-surgically (How it does or fails to alter the natural history of the disease).
3. Treat it surgically (How surgery alters the natural history of the disease and the risks).
We make recommendations, but we never make choices for the patient. We’ll guide them through all their options, but ultimately it is up to the patient to decide their course of action. Visits take longer, but patients are more involved with the process and we both live with the decisions. After the decision is made, both the doctor and the patient need to discuss how they’ll go forward with the choice and lay out expectations of each party. Sure, the doctor is responsible for fixing the broken ankle or removing the bone spurs, but the patient is also responsible for advancing his or her rehab.