Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How the costs of care impacted H. pylori treatment

Neel Butala, MD
Physician
October 4, 2014
Share
Tweet
Share

There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating him effectively would require understanding not only his medical complaints, but also his broader socioeconomic context. Working at a student-run free clinic serving a largely uninsured immigrant community has complemented my traditional medical education with important lessons about the costs of care in treating patients.

At a previous visit, Mr. J was deemed to fail his medication regimen for eradication of H. pylori, and our clinic’s referrals department was in the process of scheduling him for an endoscopy for further evaluation. As a safety net provider, our student-run free clinic has established a small network of community specialists who graciously see our patients without a fee. A referrals volunteer had been ferociously advocating the use of one of our very limited endoscopy spots for Mr. J, given the severity of his symptoms and the impact on his livelihood as a day laborer. I learned that our supervising medical directors carefully triage such cases to specialists given that our patient demand far outstrips our limited specialist supply. I was initially shocked to see how such specialist care is rationed quite literally across the railroad tracks from our super-specialist quaternary academic medical center, but realized that relying on physician goodwill alone to assuage the high costs of care for vulnerable populations was not a sustainable solution in the long run. I had witnessed the raw underbelly of a bloated system that does not systematically ration care among those with insurance, but rather haphazardly rations care away from those most vulnerable in our society.

In trying to understand the source of Mr. J’s pain and his need for endoscopy, I probed further about his medications. We had prescribed him a complex 5-drug regimen instead of a simpler 4-drug regimen to reduce his out-of-pocket costs. He eventually revealed that he had not filled one of his prescriptions, omeprazole, because it was too expensive for him. Mr. J had not failed his treatment, but rather could not even obtain it due to costs.

Furthermore, he incurred greater indirect costs in missed work and transport for additional clinic visits to resolve his mysterious persistent pain. Providers’ fundamental misunderstanding of the magnitude of the costs of care for Mr. J was leading him down a path of continued pain, extra clinic visits, and unnecessary referrals. I realized that not being aware of the costs of care can lead to waste that reverberates system-wide, especially for vulnerable populations where the relative magnitude of financial cost is high and underlying psychosocial issues can exacerbate adherence to and effectiveness of treatment.

Ultimately, we were able to use clinic funds to provide Mr. J with free omeprazole to eliminate his H. pylori infection without the need for an endoscopy and he was pain free at a follow-up visit. While I have debated the tradeoffs between autonomy, beneficence, non-maleficence, and justice with classmates in our ivory tower medical school, Mr. J put a human face on the tremendous cost problems we face as a health care system. I will always remember Mr. J’s story when I practice as a physician and work to reduce costs more broadly in a nuanced and effective manner in the future.

Inspired by Mr. J.’s case, we led an initiative to provide free omeprazole to all patients with H. pylori at our student-run free clinic. This small upfront investment would not only lead to reduced costs and lower barriers to treatment for our patients, but would also reduce unnecessary referrals, which would free up resources more broadly for our clinic. Similarly, I now believe a small investment in gaining real exposure to costs of care early in medical training can pay off in tremendous returns system-wide in the future.

Neel Butala is a resident physician.

costs_of_care_logo_small

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

Prev

The Ebola outbreak: Don't blame the nurse

October 4, 2014 Kevin 36
…
Next

How to give feedback to medical students

October 5, 2014 Kevin 2
…

Tagged as: Gastroenterology, Medications

Post navigation

< Previous Post
The Ebola outbreak: Don't blame the nurse
Next Post >
How to give feedback to medical students

ADVERTISEMENT

More in Physician

  • Love, birds, and fries: a story of innocence and connection

    Dr. Damane Zehra
  • The overlooked power of billing in primary care

    Jerina Gani, MD, MPH
  • Why pain doctors face unfair scrutiny and harsh penalties in California

    Kayvan Haddadan, MD
  • Why physicians need a place to fall apart

    Annia Raja, PhD
  • The joy of teaching medicine through life’s toughest challenges

    John F. McGeehan, MD
  • Why health care can’t survive on no-fail missions alone

    Wendy Schofer, MD
  • Most Popular

  • Past Week

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
    • A new telehealth model for adolescent obesity [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • A new telehealth model for adolescent obesity [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • Why the future of cancer prevention starts from within

      Raphael E. Cuomo, PhD | Conditions
    • A new approach to South Asian heart health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
    • Inside the final hours of a failed lung transplant

      Jonathan Friedman, RN | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
    • A new telehealth model for adolescent obesity [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • A new telehealth model for adolescent obesity [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • Why the future of cancer prevention starts from within

      Raphael E. Cuomo, PhD | Conditions
    • A new approach to South Asian heart health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
    • Inside the final hours of a failed lung transplant

      Jonathan Friedman, RN | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...