Talking About the Cost of Care



Stethoscope wrapped around hundred dollar bills

It turns out most doctors don’t discuss costs with patients. Here is what a new study found:

  • The researchers analyzed transcripts of almost 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested that the cost of care might be difficult to afford and assessed how doctors responded.
  • Researchers noted two ways in which doctors dismissed patients’ financial woes. They either did not acknowledge the concerns patients expressed or only half-addressed them.
  • Doctors discussed medical costs with patients about 30 percent of the time; and, in only about 40 percent of those discussions did doctors and patients brainstorm about ways to make medication more affordable.

Sometimes it seems doctors cannot win. In a system now built for seven minute appointments they are now held responsible for not discussing costs?  But I have seen it with my own family.   Doctors have ordered unaffordable drugs for my son and couldn’t care less that he couldn’t afford it.  This is an issue.

How do you fix this?  Easy.  Direct Primary Care.  My colleagues and I spend a lot of time going over the costs of medicine with patients.  We find them deals using such sites at  We find them cheaper X-rays, MRIs, stress echoes, etc.   Patients appreciate this and this saves them money and in many ways negates our monthly fee. I had one patient save $150 a month just on her son’s ADD medicine.  It was the same medicine at the same pharmacy.  Her insurance wouldn’t pay a dime so they were paying out of pocket.  Using a coupon, I saved them enough to cover my monthly membership fee.  I did this because I have time and that is because I have less patients.  That is what DPC is all about.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Talking About the Cost of Care

  1. Pat
    April 12, 2016 at 6:29 pm

    I will keep saying this on this site: DPC is the only truly transparent, truly honest medical care available. Everything from working full-time ED (me), to in-patient, to “wellness exams” covered by private insurance, to your local family doc that accepts Medicare/Medicaid is corrupted.

  2. Steve O'
    April 12, 2016 at 9:00 am

    The big players go out of their way to keep doctors UN-informed about costs. How do they think we know? Blaming the doctor for not being interested in prices is the same as blaming the consumer. The trick to insurance company profits is uncertainty about expenses incurred. Will the ER visit be $500 or $6000? If there’s no simple system to figure out how much the visit is, people won’t go.

  3. Perry
    April 12, 2016 at 8:50 am

    ” That is what DPC is all about.”
    Indeed, in fact that is what all medical care should be about. Unfortunately, it has been hijacked by third parties.

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