Journal of General Internal Medicine

, Volume 29, Issue 9, pp 1234–1241 | Cite as

Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care

  • Amber K. Sabbatini
  • Jon C. Tilburt
  • Eric G. Campbell
  • Robert D. Sheeler
  • Jason S. Egginton
  • Susan D. Goold
Original Research



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.


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.


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.


Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012


Iterative thematic content analysis of focus group transcripts


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.


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.


physician stewardship cost-conscious care health care costs physician decision-making 



The authors would like to thank Greenwall Foundation for the support of this work.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2014_2898_MOESM1_ESM.pdf (26 kb)
ESM 1(PDF 26 kb)


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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Amber K. Sabbatini
    • 1
  • Jon C. Tilburt
    • 2
    • 3
    • 4
  • Eric G. Campbell
    • 5
    • 6
  • Robert D. Sheeler
    • 7
  • Jason S. Egginton
    • 4
  • Susan D. Goold
    • 8
    • 9
  1. 1.Department of Emergency MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Division of General Internal MedicineMayo ClinicRochesterUSA
  3. 3.Biomedical Ethics Research UnitMayo ClinicRochesterUSA
  4. 4.Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  5. 5.Department of MedicineHarvard Medical SchoolBostonUSA
  6. 6.Mongan Institute for Health PolicyMassachusetts General HospitalBostonUSA
  7. 7.Department of Family MedicineMayo ClinicRochesterUSA
  8. 8.Department of Medicine and Health Management and PolicyUniversity of MichiganAnn ArborUSA
  9. 9.Center for Bioethics and Social Sciences in MedicineAnn ArborUSA

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