title: Controlling health costs: physician responses to patient expectations for medical care.
abstract: BACKGROUND
  Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary.
  
  
  OBJECTIVE
  To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care.
  
  
  METHODS
  Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services.
  
  
  METHODS
  Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts
  
  
  RESULTS
  Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment.
  
  
  CONCLUSIONS
  Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.
authors.affiliation: Department of Emergency Medicine, University of Michigan, NCRC,2800 Plymouth Rd, Building 10, Room G015, Ann Arbor, MI, 48109-2800, USA, asabbati@med.umich.edu.
authors.forename: Amber K
authors.initials: AK
authors.lastname: Sabbatini
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.forename: Eric G
authors.initials: EG
authors.lastname: Campbell
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sheeler
authors.forename: Jason S
authors.initials: JS
authors.lastname: Egginton
authors.forename: Susan D
authors.initials: SD
authors.lastname: Goold
mesh_terms: D005260:Female; D017144:Focus Groups / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D008297:Male; D005791:Patient Care / Q000191:economics* / Q000379:methods; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D010819:Physician's Role; D010817:Physician-Patient Relations