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Talking about money is never easy. But when doctors are reluctant to talk about medical costs, a patient鈥檚 health can be undermined. published in Monday鈥檚 Health Affairs explores the dynamics that can trigger that scenario.

Patients are for shouldering more of their own health costs. In theory, that鈥檚 supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to valuable preventive care and superfluous services alike.

Doctors could play a key role in instead helping patients find appropriate and affordable care by talking to them about their out-of-pocket costs. But, a range of physician behaviors currently stands in the way, according to the study.

鈥淲e need to prepare physicians to hold more productive conversations about health care expenses with their patients,鈥� said Peter Ubel, the study鈥檚 main author and a physician and behavioral scientist at Duke University.

The researchers analyzed transcripts of almost 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested that the cost of care might be difficult to afford and assessed how doctors responded.

Overall, researchers noted two ways in which doctors dismissed patients鈥� financial woes. They either did not acknowledge the concerns patients expressed or only half-addressed them. For instance, if a patient commented on how expensive a drug was, the doctor might ignore the comment entirely or might suggest a temporary solution 鈥� like a free trial 鈥� without exploring long-term strategies to address the issue.

And, without such a long-term plan, patients may eventually stop taking the medication, or take it irregularly. That can harm their health, and even send them to the hospital.

The study doesn鈥檛 measure how often doctors dismissed patient concerns 鈥� because, the researchers wrote, they didn鈥檛 know how often those dismissals led to people actually foregoing needed treatments.

Still, Ubel said, it is clear doctors are not talking to patients about these expenses. He pointed to of those same conversations, which found that doctors discussed medical costs with patients about 30 percent of the time; and, in only about 40 percent of those discussions did doctors and patients brainstorm about ways to make medication more affordable.

鈥淎 majority of [physicians] 鈥� they don鈥檛 talk about costs,鈥� he said. 鈥淲hen they do talk about it, they don鈥檛 talk about it productively.鈥�

Why do physicians hesitate? For one thing, they aren鈥檛 used to discussing cost barriers, and many think it鈥檚 inappropriate to bring up money at all, Ubel said. When he lectures on the subject, he always encounters people who worry discussing finances will 鈥渃ontaminate the doctor-patient relationship.鈥�

Plus, doctors haven鈥檛 been taught to listen for patients鈥� pocketbook concerns. If a patient comes in with heartburn and indigestion, a good internist will immediately start probing for signs of coronary disease, Ubel said. By contrast, physicians aren鈥檛 primed to pick up on cues that patients may face financial strains.

鈥淚f we had that on our list to be aware of, we鈥檇 pick up the cues. If we don鈥檛, it鈥檒l be right in front of our eyes, and we鈥檒l miss it,鈥� he added.

The idea of patients acting as consumers 鈥� weighing cost and shopping for the best health care deal 鈥� is still relatively new, the study notes. As it becomes more commonplace, patients may push doctors for more help in making cost-based decisions, Ubel said.

That said, navigating a patient鈥檚 financial circumstances and medical needs in the course of a 15-minute visit is tricky, said Jonathan Kolstad, an assistant professor of economic analysis and policy at the University of California, Berkeley. Kolstad wasn鈥檛 involved in the Health Affairs study but has researched how medical costs affect people鈥檚 decision-making.

鈥淚t鈥檚 not as though, 鈥極h, it鈥檚 just consumers can鈥檛 figure it out.鈥� Doctors don鈥檛 know,鈥� he said. When it comes to figuring out what a drug will cost, 鈥渄octors are in the same boat.鈥�

KHN鈥檚 coverage of prescription drug development, costs and pricing is supported in part by the .