Increased cost sharing, in the forms of higher co-payments, deductibles, and yearly maximums, has been advocated to encourage patients to become smarter consumers and thus to reduce the overall cost of medical care. High out-of-pocket costs, however, can cause care to be delayed or foregone and can lead to financial distress and even bankruptcy. Some argue that physicians should be more cognizant of their patients’ out-of-pocket costs, not for the sake of society but for the sake of the patient.1 In our view, physicians have an ethical duty, at a minimum, to discuss out-of-pocket costs with patients in the same way that they would discuss the adverse effects of a treatment.2 But when physicians actually begin to consider out-of-pocket costs as part of clinical decision making, the challenges can seem overwhelming. We examine potential barriers to discussing out-of-pocket costs with patients and provide guidance on how physicians can overcome these barriers.
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