Cost Containment in Medical Curriculum : Health care: Survey finds many schools are teaching students how to hold down costs. Some offer an elective course; others make it mandatory.

Elissa Falzetta didn’t think her patient needed to be tested for a urinary infection. The antibiotics he was taking for pneumonia also would cover a urinary infection, the University of Cincinnati medical student reasoned.

Her superior didn’t agree and ordered the urinary culture. The test showed no infection.

For Falzetta, the moral of the story was clear: Hospitals and doctors need to learn to control costs.

Medical schools around the country have begun to do that by teaching their students some economics as well as anatomy. A 1994 survey by the Assn. of American Medical Colleges found that 101 U.S. medical schools teach students how to hold down health care costs.

Some teach cost containment as an elective. A few, including the University of Cincinnati College of Medicine, have a mandatory course on the subject.

The University of Cincinnati course, for third-year medical students, was required for the first time this year.

Course director Dr. Saad Ghosn said he tries to teach students to practice good medicine without being excessive. That means learning which are the best tools to make a diagnosis.

“There is no need to do everything under the horizon,” he said. “You need to know what to do and what not to do.”

To pass, students must attend at least 12 of the 20 1 1/2-hour classes and write a paper about some aspect of cost containment.

Falzetta said the class has taught her to think more about why she is ordering tests and whether there’s a cheaper way to get the same information about a patient’s condition.

“This is somebody’s money,” she said. “It may not be mine, but it’s somebody’s.”

Critics say medical schools aren’t doing enough to teach cost containment.

Doctors have “abused their patients economically, over-medicated them, overcharged them,” said Charles Inlander, president of the People’s Medical Society, a national consumer health advocacy group based in Allentown, Pa. The 85,000-member group is affiliated with Rodale Press, which publishes Prevention and other magazines and books.

“I’m not enamored by a medical school teaching one course in cost containment,” Inlander said. “The system is so rampantly bad, when they get out to practice, they aren’t thinking about what it’s costing.

“The problem isn’t so much in medical school. The problem is after they get out. They have to pay all the bills, for school and for the lifestyle they feel they’ve earned.”

Dr. Dan Blazer, dean of education at Duke University Medical Center in Durham, N.C., conceded that doctors until recently haven’t been trained to think about costs.

“The more tests you ordered, the better. . . . Volume was the way in which most hospitals and most physicians were able to realize increased income,” he said.

But medical practice is changing, as insurance companies force patients to leave hospitals sooner and refuse to approve certain costly treatments, he said.

To prepare doctors-to-be for the changes, Duke requires its second-year medical students take a two-week cost-consciousness “clerkship.”

The students interview hospital patients and study their hospital bills as well as their illnesses. The process helps students learn the costs of drugs and tests, Blazer said.

For example, he said, “Many of them had no idea how much an MRI scan costs.” An MRI, short for magnetic resonance imaging, typically costs $700 to $800.

As patients shop for more economical health care, doctors must learn to cut costs--or go out of business, said Dr. John Tolmie, associate dean for academic affairs at Wake Forest University’s medical school in Winston-Salem, N.C.

“Doctors are perceiving that their future security is dependent upon a more economic approach to medicine,” he said. “My sense is that patients are going to benefit enormously from this.”

Cost-consciousness training is important for residents as well as medical students, said Dr. William Jacott.

At the University of Minnesota in Minneapolis, where Jacott is a family physician, residents spend a few days with the medical clinic’s manager to learn about billing, overhead and other costs.