Reflection: Week 3 NR603 - Brecken Moore

In this week’s reflection, I reviewed the case of a patient suspected of having Chronic Obstructive Pulmonary Disease (COPD). The total cost of the diagnostic workup for this patient, including an EKG, Echo, CT scan, chest X-ray, CBC, D-Dimer, BNP, ABG, and Pulmonary Function Test (PFT), amounted to $4,124. This considerable expense necessitates a strategic approach to balance comprehensive care with cost-effective measures, particularly for patients with limited financial resources.

Given the severity of the patient’s symptoms, my diagnostic strategy would prioritize essential and high-yield tests. Instead of a basic chest X-ray, I would opt for a CT scan as the initial imaging study. The CT scan offers a more detailed view of the lungs, which is crucial for accurately diagnosing and assessing the extent of COPD. Additionally, I would recommend a CBC, which could be drawn at a free clinic to reduce the patient’s out-of-pocket expenses.

Beyond imaging, a Pulmonary Function Test (PFT) is critical in assessing the functional status of the lungs and confirming the diagnosis of COPD. An echocardiogram would also be necessary due to the patient’s symptoms that suggest potential cardiac involvement. These tests are essential for both diagnosis and the formulation of an effective treatment plan.

If the patient exhibited no signs of heart failure, further cost reductions could be achieved by forgoing certain tests, such as the BNP or ABG. However, the presence of worrisome cardiac symptoms makes it imperative to conduct a thorough evaluation, which justifies the inclusion of these tests in the workup.

Furthermore, to assist the patient in managing healthcare costs, I would explore options at free clinics for any diagnostic studies that could be performed at a lower cost or no cost at all. Additionally, I would connect the patient with a social worker to assist in securing federal or state-funded insurance, ensuring they have access to the necessary care without undue financial burden.

In summary, while the cost of the full diagnostic workup for COPD is significant, prioritizing essential tests and utilizing available resources can provide a balanced approach to patient care. It is vital for healthcare providers to consider the financial implications for low-income patients and to advocate for resources that can support their access to care.