Doctors should have an ethical obligation to warn patients about the cost of any test or intervention they recommend and provide an alternative in cases where it is unaffordable, a leading health economist says.

The idea is one of several additions that Dr Stephen Duckett, director of the Grattan Institute’s Health Program, recommends be added to the Medical Board of Australia’s latest draft revised Good Medical Practice: A Code of Conduct for doctors in Australia which he says are needed to address key barriers to healthcare.

In his submission, Dr Duckett highlights the issue of out-of-pocket costs being responsible for over 500,000 patients putting off or not seeing a specialist in 2016-17 and also for more than 250,000 patients delaying or not obtaining imaging.

He argues that doctors making treatment and referral decisions “should have some responsibility for the entire episode of care involved in the consultation”.

“As some patients can’t afford the out-of-pocket charges involved in diagnostic tests and specialist consultations the revised code needs to encourage doctors to consider this issue and provide patients with options, Dr Duckett writes.

“The Code should establish an obligation on doctors to provide patients with available information about the costs of referrals and to provide clear information on, and facilitate access to, alternatives where patients indicate that fees are a barrier to care.”

Other recommendations include:

• Doctors should charge fees that are no more than fair and reasonable in the circumstances, similar to one used in the legal profession;
• Doctors should give patients information on indicative fees for possible procedures in advance of consultations;
• Doctors must ensure that patients are fully aware of the tests being ordered for them and the risks that results could lead to overdiagnosis;
• The use of treatments that are novel, or novel in the setting, should be subject to research oversight;
• Doctors must ensure their personal views do not adversely affect referrals being made