Students' clinical management decisions: use of a tool to increase awareness of cost

Abstract

Background: The overuse of medical resources is a global issue, often resulting in more harm than good. Within the United States, almost one-third of medical spending is unnecessary, with physicians being responsible for an estimated 10% of this waste, primarily through lack of care coordination and overtreatment. Identifying opportunities for cost savings while delivering quality care is a core competency requirement for all medical specialties. We took a pragmatic approach to improve medical students' decision-making in different contexts to assist them in understanding contextual factors when ordering care. Methods: This study retrospectively reviewed 193 high-value care prescriptions. Prescriptions were completed by 4th-year medical students completing a rotation in an outpatient, inpatient, or emergency room setting
during the 2020 and 2021 academic years. Indicators of interest included underlying reasons for testing, whether non-clinical effects of tests were considered, who the students discussed costs with, and whether students believed the course changed the management of the patient. Results: A majority of students described downstream effects on the healthcare system and effects related to patients, such as cost, time, transportation, stress or anxiety, missed work, and childcare. The financial cost was one of the primary considerations for patients, yet it was not routinely discussed with patients. Most students felt that the prescription tool did not change the management of the current patient. However, they did feel that the tool changed their approach to future patients with the same problem, which was the goal of this project. Conclusion: There is a need to consider the valuefor patients and the cost to the health care system when ordering tests and procedures. More workmust be done to encourage consideration and conversations about finances and socialdeterminants of health amongst all team members, including patients.