Table 1.

Communication Strategies

Emphasis	Language
Fairness	“Everyone is interested in keeping health   care costs down and we’re trying to do so in   a fair way. In this situation, I’d recommend   a CT scan to any of my patients.”
Shared sacrifice	“It’s good for us to share responsibility for   keeping health care costs down. At the end   of the day, we all pick up the tab when we   pursue expensive care because premiums   rise. Keeping costs down for health plans or   Medicare or Medicaid helps you personally   in the long run.”
Threshold of “good enough” rather than optimization	“I really do think that a CT scan can   be a reasonable option for you. It might   not find quite as many things as an MRI,   but I believe it will find the important   things I am concerned about. It is   certainly good enough for what we   are trying to do.”
Shared decision-  making	“What are your thoughts about going with   the CT scan? Let’s talk about whether the   MRI is worth the extra $500 that your   insurer or Medicare or Medicaid would   be paying.”