Talking about cost in private practice: suggesting an extra test without sounding like a salesperson

“Why do I need another test?” is a reasonable question

After a consultation, a patient hears that it would be worth considering a further test costing several hundred zlotys. She is surprised, because she had not known that an additional cost would come up during a single appointment. She asks: “Do I really need this, or is the practice just offering another service?” The doctor may feel accused and reply: “If you didn’t need it, I wouldn’t be suggesting it.” But a retort like that rests solely on authority and does not explain the decision. It is better to go back to the purpose: “I suggested this test because we want to establish whether a specific problem is causing your symptoms. The result can help us decide what to do next. Let’s also talk about the other options.” Asking about cost is not a sign of mistrust in the doctor. For the patient, the expense may be a serious burden. A person can want to look after their health and, at the same time, worry about an expense that will strain the family budget. An honest conversation should make room for both.

The medical indication must be kept separate from the price

The first question is this: is the test justified by the patient’s condition and current medical knowledge? Only then does the question of arrangements and payment come in. The doctor should set out which diagnostic problem the result is meant to resolve, to what extent the result may affect further management and what the test’s limitations are. In some situations a test is necessary or urgent; in others it provides additional information but does not change management. These situations should not be mixed up. A line such as “Let’s do the full set so we can rest easy” does not show what the patient actually gains. It is more useful to say: “If the result is positive, we’ll consider this route. If it’s negative, we’ll narrow down the list of possible causes.” Equally important is information about a comparable test that is publicly funded, available at another facility or possible to carry out later, provided this is clinically justified. A paid offer should not replace a thorough discussion of the indications.

Patients have a right to know their options

The patient’s right to information covers the proposed and possible diagnostic and treatment methods, as well as the foreseeable consequences of using them or not using them. This is the natural place to compare the options. You might say: “We have three routes. We can do the test now, use the available publicly funded pathway if you meet the criteria, or, in certain circumstances, monitor the situation first. Let’s go through their limitations and the waiting times.” Don’t suggest options that do not exist in the particular case. If the procedure is urgent, explain clearly why a delay could be dangerous, rather than presenting the paid option as the only one without checking the facts. When asked “And what if I don’t have it done?”, answer in terms of the real medical consequences, without making the patient feel guilty. A person who has the right to choose needs information presented in language they can understand, not the language of a sales pitch.

How to talk about money without causing embarrassment

Price can be an embarrassing subject. A patient may not say straight away that they cannot afford something, and a doctor may avoid asking about cost for fear of slipping into the role of a salesperson. Yet in a 2016 study by Hunter and colleagues, based on an analysis of conversations during outpatient appointments in the US, participants discussed various ways of reducing expenses, including changes in logistics and the alternatives available. The study does not describe Polish practices, nor does it prove that every question about budget improves treatment outcomes. It does show, however, that costs can be the subject of an ordinary, matter-of-fact clinical conversation. You can ask: “Would the cost of this test be a significant difficulty for you?” That is better than “But health is priceless.” If the patient says yes, look for options that are genuinely available, without automatically assuming they will give up on testing. Financial difficulties are not a sign that someone neglects their own health.

Refusal does not have to mean the end of working together

“I don’t want to spend that amount right now” may mean a lack of money, a need to think it over or a sense that the information is incomplete. Instead of pushing, ask: “What’s the biggest obstacle for you today: the cost, an unclear purpose or worries about the test itself?” Then go back to the clinical facts. If the patient refuses after receiving accessible information, the doctor should act in line with the law and the standard of care, record the relevant findings and agree on a safe plan going forward. You must not punish the patient for refusing by adopting a cold or dismissive tone: “If you don’t want it, then I can’t help you.” In some situations, the risks of not acting and the urgent options available need to be discussed clearly. Respecting autonomy does not mean giving up on communicating information responsibly. It is worth leaving the door open to revisit the decision without shaming the patient and without hidden pressure to buy a service.

The consulting room and reception must speak with one voice

Even a good conversation with the doctor can lose its point if the patient hears something completely different at the payment stage. The doctor says “this is one of the options”, and reception says: “You need to book today, otherwise you’ll lose the slot.” Or the patient only hears the price after the test. That is why a facility needs clear rules: who explains the indications, who gives the full cost, how information about available appointments is provided and whether additional charges may arise. Administrative staff should not decide for themselves whether diagnostics are justified, or stand in for the doctor in explaining medical risks. They can, however, provide a verified price list and explain how to get information about alternatives. An example of what reception might say: “The cost is a set amount. If you’d like to discuss the purpose of the test and the other options, I’ll pass your question on to the doctor.” Consistent information builds trust. The patient should not have to wonder whether they are getting a medical recommendation or a sales offer.

Charging for a test does not in itself mean the doctor is trying to sell something. What matters is the clinical justification, clear information about costs and alternatives, and the freedom to ask questions. The patient should understand how the result may affect further treatment, what the consequences of not having the test are and what they can do if they do not want to or cannot pay. A thorough explanation builds trust more effectively than any persuasion technique.

How Em helps you prepare a conversation about the cost of a test

A doctor is considering recommending an additional test to a patient. She knows it could help establish the cause of his symptoms, but she is worried that the patient will see the suggestion as an attempt to increase the bill. Before the appointment, she describes the general situation to Em, without medical records or patient data. She asks for two versions of an explanation, each of which clearly separates the purpose of the test from its price. Em helps her practise answering the questions “Do I have to have it?” and “What happens if I say no?” Afterwards, she checks that the wording matches the actual indications and the diagnostic options available. She can also prepare a short brief for reception so that the patient does not receive conflicting messages. Empatyzer supports the quality of the conversation; it does not determine clinical indications, the price or the decision to perform the test. As a result, the patient can make an informed choice, understanding both the medical rationale for the recommendation and its financial implications.