My financial prescription for ailing patients

June 6, 2008

Help ease your patients' money problems, and you may improve their health, says the author.

Money woes are difficult to talk about with anybody, but they're an especially difficult issue for physicians to raise with patients. And yet it's essential that we do so.

In my experience, financial stress is one of the biggest root causes of many of the problems that we see and treat every day-including depression, anxiety, insomnia, hypertension, and irritable bowel syndrome, to name a few. When we ignore the financial underpinnings of such ailments or deal with these underpinnings in a perfunctory or offhand manner, we can unwittingly make matters worse. This is especially true when patients face unusual financial difficulty or are financially illiterate.

Hard times take a physical toll

Despite her degenerative arthritis of the spine and major joints, 53-year-old Fran (not her real name) held down two jobs in order to make ends meet. Recently, she was so sleep deprived from working these two jobs that she wrecked her car. Her injuries, though not life threatening, caused her to lose both jobs and her health coverage. Unable to pay her medical bills and other expenses, Fran was forced to live in her damaged car this winter.

Then there's Susan. Like many of my diabetic patients, she finds it especially tough to control her blood sugar, blood pressure, and vitamin deficiencies because she can't afford good quality food. Working long hours, she also struggles to do some of the other things she should-exercise, keep routine medical appointments, follow cancer screening guidelines, and attend patient education classes.

I do my best to offer such patients the most cost-effective care I can. In Susan's case, I was able to use discount pharmacy initiatives to change her brand medications to generics. These were even less expensive than the formulary drugs preferred by her health plan, and ended up saving her more than $450 a year.

Financial and health management go hand in hand

But that's not all I do for my patients. I also try to educate them about good money management, on the theory that it's better to teach people to fish than to hand them a fish.

My wife (a pediatrician) and I learned this lesson the hard way. We were almost buried financially from the staggering amount of our medical school debt, compounded by our relatively meager wages in residency, by the fact that we received no financial instruction up through medical school, and by our inappropriately low reimbursements as primary care physicians. Thomas Stanley's The Millionaire Next Door: The Surprising Secrets of America's Wealthy inspired us to get our financial house in order. After consulting another book (The Four Laws of Debt-Free Prosperity, by Blaine Harris), we placed both our debts and our annual budget on an Excel spreadsheet, a practice we continue to this day.

While I recognize that not all financial problems are the result of poor money management, I've found that financial teaching tools can-and do-help many patients. I prefer Dave Ramsey's The Total Money Makeover: A Proven Plan for Financial Fitness (Thomas Nelson, 2nd ed.), but also find Your Money or Your Life: Transforming Your Relationship with Money and Achieving Financial Independence (by Joe Dominguez and Vicki Robin) to be handy for exam room counseling.

By following the principles outlined in these books, I've seen patients and families turn their lives around, and not just financially. Consider Joe and Sally, two of my patients, who discovered that the same discipline and planning that helped them pay off both their credit card debt and car loans and put some money in the bank also helped them to manage their daily caloric intake better. In fact, since my first "financial" session with the couple, Joe has lost 40 pounds and Sally's lost 25, allowing me to wean them off their prescription medications.

This approach, of course, doesn't work with everybody. Take Tracy, who before coming in for a visit had developed a host of problems-weight and hair loss, a tremor, diarrhea, high blood pressure, and an elevated heart rate. Her family, desperate to get her help, brought her in to see me. At the end of my evaluation, it was apparent to me that Tracy's medical problems stemmed from her financial crisis. She and her husband, who were in the process of building a new house, had maxed out their credit cards and were about to have both their trailer and car repossessed. Their marriage was also in trouble, owing in part to their deteriorating financial situation.

During the course of my extended exam, I explained my findings to Tracy, while giving her some resources that I believed would help mend both her finances and her health. After that visit, however, I never saw her again.

We can't get all patients to do what they need to, whether that means changing their diet or changing their financial behavior. But in neither case should we stop trying, since both a bad diet and reckless spending can have a major impact on physical health and wellbeing.