First Do No Harm: How to Use Our Guide

This is an action-oriented guide directed at physicians, nurses, community health workers, and other frontline healthcare professionals who want to step into the champion space.

Drawing on practices shared by engaged clinicians, the guide helps you build your skills and feel empowered to address medical debt with and for your patients.

Give Yourself a Check Up

What are the attributes of a clinician champion? A list of qualities drawn from patients and clinicians help you self-reflect on areas of strength and opportunity.

Tools You Can Use

We spoke with a range of healthcare workers who shared the tools, internal systems, and community resources they use most when helping patients navigate the cost of care. Clinicians noted that available tools are too few, but shared the ones they find most useful.

Find Your Story

Take a look at the story arc developed from our 1:1 deep dive clinician interviews. Use this as a guide for developing and tailoring your own pitch and take a shot at nailing down your elevator speech.

Explore the Path of Engagement

The end of the guide illustrates concrete actions that clinicians can take to show up as champions to end medical debt. Where are you on the path?

What Makes a Clinician Champion?

Clinician champions are healthcare professionals who recognize the impact of medical debt on their patients—and themselves—and are ready to make a difference.

They share stories in the media and at work about how medical debt disrupts the patient-clinician relationship, forcing patients to delay or forgo medically necessary care.

Give Yourself a Checkup!

We asked patients with medical debt to reflect on what they need from their doctor and what makes someone a champion to end medical debt. We combined those insights with the attributes shared by our clinician champions in 1:1 interviews.

Take a look at the list below and give yourself a check-up.

Dr. Caroline Sloan

Dr. Sloan is a General Internist and Assistant Professor of Medicine and in Population Health Sciences at Duke University School of Medicine. As well, she is Core Faculty Member, Duke Margolis Institute for Health Policy, and Member of the Duke Cancer Institute. Her clinical interests are in primary care for vulnerable populations and patients with multiple chronic conditions. Her research interests focus on the role that money plays in medical decision-making. She currently studies financial barriers to care for patients with multiple chronic conditions, the impact of recent price transparency regulations, and the ways that doctors and patients communicate about and make decisions based on out-of-pocket costs.

Dr. Renee Crichlow

Renee Crichlow, MD, FAAFP, practiced full-spectrum Family Medicine with Obstetrics for more than 20 years and is now the chief medical officer of Codman Square Health Center in Boston, a Vice-chair at the Boston University Medical School Department of Family Medicine, and is she is also a Lecturer at the Harvard University Chan School of Public Health.

Dr. Crichlow has lived and worked in both rural and urban environments. She and her family lived for six years in Red Lodge, Montana when Dr. Crichlow was seeing patients and teaching Family Medicine at a federally qualified community health center in Billings, Montana.

She is a Commissioner for Federal and State Policy for the American Academy of Family Physician, and is also on the national Board of Directors and the Immediate Past President of the Society of Teachers of Family Medicine and the founder of The Ladder, a mentorship program for kids interested in health careers.

Dr. Benjamin Springgate

Benjamin Springgate M.D., M.P.H., F.A.C.P. is a Professor of Medicine, Chief of the Section of Community and Population Medicine, and Vice-Chair for Clinical Affairs in the Department of Medicine at the LSU School of Medicine-New Orleans. He is a Professor of Community Health Science and Policy at LSU School of Public Health, and Director of the Center for Healthcare Value and Equity at LSU Health Sciences Center-New Orleans. Dr. Springgate, an internist and health services researcher, co-founded and leads the LSU Integrated Health Clinic at University Medical Center in New Orleans, Louisiana’s only academic primary care center focused on care of patients with opioid use disorder and other substance use challenges. Dr. Springgate directs the LSU Health MD/MPH Dual Degree Program, training the next generation of physician leaders in public health.

Dr. Amir Varedi

Dr. Varedi, MD, MPH is a board-certified internal medicine physician (ABIM) and hospitalist with a background in clinical research focused on cancer prevention and public health. Dr. Varedi has extensive experience managing patients across inpatient, outpatient, and telehealth settings, with a patient-centered approach that emphasizes evidence-based care. In addition to clinical practice, Dr. Varedi has a strong interest in healthcare leadership and policy, with a focus on improving health systems and advancing public health initiatives to enhance patient outcomes on a broader scale.

Dr. Angad Singh

Dr. Angad Singh is a practicing Family Medicine and Clinical Informatics physician and Clinical Assistant Professor at the University of Washington in Seattle, Washington. He serves as Associate Chief Clinical Information Officer for UW Medicine and holds appointments in the Departments of Family Medicine and Biomedical Informatics & Medical Education. He is a core faculty member for the Clinical Informatics fellowship and has received the Teacher of the Year award in 2022 and 2024. He also co-chairs UW Medicine’s Social Drivers of Health workgroup and has served on multiple UW School of Medicine committees, including the Executive Admissions Committee. He is the recipient of the 2024 David B. Thorud Leadership Award, the highest leadership honor given at the University of Washington.

Champion Attributes from Patients:

Welcoming, Warm & Curious

Patients want to feel comfortable raising their fears about medical debt – trust is built on connection

“As we try to talk with patients about difficult financial situations that they may be facing, I think we want to be able to convey humility and we also want to be able to convey a sense of normalization…”More—something like, I don’t know what your situation may be, but I know for a lot of my patients right now making ends meet can be pretty tough.”

— Dr. Springgate Bio

“I think building trust with patients comes down to being able to connect with them in a way that they’re able to understand that you relate to their concerns, you know, as a patient and as a human being…” More and that you’re not just functioning as this…robotic, physician, medical figure.”

— Dr. Varedi Bio

“I think I just try as hard as I can to be as non-judgmental as possible… you just ask in a straightforward way and you’re not afraid.…” More And I think after I did it a few times and people weren’t upset, now I feel totally comfortable. And I’ve seen patients for the very first time, never met them before, and I ask them if stuff is affordable. So, I think it’s actually not so much about trust. It’s just about not being judgmental.”

— Dr. Sloan Bio

A Problem Solver & Connector

Patients want their clinicians to be knowledgeable about potential solutions and resources for them

“It doesn’t mean you have to become the social worker. It just means that you have to be able to say, ‘Hey, you know what? I’m hearing that you’re stressed about your housing right now. I’m hearing that you’re stressed about your transportation, or you’re stressed about something else that you can’t afford. Have you checked out this resource guide?…” More Look, this is the website that it’s on. Oh, here’s a print copy. Why don’t you go ahead and take one? Maybe it has something in there that’ll be helpful to you.”

— Dr. Springgate Bio

“Knowing the resources that your own organization has, knowing that you don’t have to be the one that fixes all the problems, but you can help get someone set up on the path to get the support, I think that makes it a lot easier to have those conversations.”

— Dr. Crichlow Bio

“I think in many communities, there are resource guides that exist. They’re sometimes put together by larger groups like the United Way. They’re sometimes put together by faith-based organizations. They’re sometimes put together by the city or the county. But these types of…” resource guides can be really valuable in helping people to identify opportunities to tap into things that they didn’t know about that could be helpful. And I think it’s really valuable for physicians and health care providers to know about those.” More

— Dr. Springgate Bio

Supportive of Patient Agency

Patients want clinicians to respect and create space for their decisions about their care

“I always normalize choice…so if you go to the pharmacy and I sent you a prescription and it happens to be way more than you’re thinking, when there is no medical necessity to this particular choice…I’ll say, “hey if it looks like it’s a really high number, just let me know because we have equally effective options that you may or may not get covered with insurance.”… And normalizing choice and agency and autonomy for them to know that they can say no…they don’t have to pick up everything I prescribe. They can say, “no, I’m going to pick that up later,” or they won’t pick it up at all. And this medication is not a requirement, there’s no contract for you to have to pick it up.” More

— Dr. Singh Bio

“I think it does require an individualized approach based on the patient and what they’re bringing to the table at the current time…I think we also need to meet patients where they are, and hear what they’re saying about when they want to discuss it, and what they’re comfortable with…”

— Dr. Varedi Bio

An Advocate

Patients want clinicians to advocate on their behalf when there are frustrations around insurance and billing

“I mostly focus on trying to prevent people from having high cost, which is a huge issue in my clinic. A lot of people have trouble affording just the basic medications that they need or the co-pays for their appointments. And so my focus was really on,… how do we get you the care you need with the fewest medications possible without having to see all the specialists if finances are an issue for you.” More

— Dr. Sloan Bio

“It’s always a part of my practice and in how I’m engaging with my patients, and we often have explicit discussions about, “oh, you need to see an otolaryngologist, okay, you know, the place that you can go that will accept your insurance that isn’t going to put you on a 12-month waitlist is this one… Let me…write down the name and phone number for you right now, rather than going through the electronic health record referral process, which will route you to places that will offer you something else.” More

— Dr. Springgate Bio

Deeply Empathetic

Patients want clinicians who are willing to step into their shoes—even when they cannot solve their affordability challenges

“You have to be able to create that space where you can say, “hey, being vulnerable about your financial situation, it’s not a shameful thing, it’s actually a proactive way of engaging so we can keep you healthy.”

— Dr. Crichlow Bio

“And so, I think by normalizing it, by making it seem like it’s not about them, it’s not a moral failing…” that they’re not able to afford healthcare necessarily, this is simply in the context of inflation, of rising prices, of something that everyone deals with that everyone needs a hand and we are all just there to try to help each other out.” More

— Dr. Springgate Bio

We encourage you to explore the full guide, which includes more information and tools shared by fellow health professionals.

Tools You Can Use

We collated a list of commonly used tools shared by clinicians in our focus groups and deep-dive interviews; these range from social workers, financial counselors, and health insurance navigators in their own workplaces to low-cost drug options like Cost Plus Drug Company and GoodRx. Resources (and even job titles and roles) will look different based on your work environment, so the list within the guide is intended to provide a general overview and spark conversation—is your institution doing something innovative you’d like to share? Is there a new practice on this list you could bring to your own work?

While most clinicians feel that social workers and financial counselors are overtaxed, they continue to rely on them to help navigate available financial support for patients. Here are some important things to know:

Locate and understand your institution’s financial assistance policy (FAP) – who does it help and are you a participating clinician?
Does your institution make information on financial assistance and other supports easily accessible to patients, i.e. through posted flyers, on bills, or linked in the patient portal?
Do you have a sliding scale for payment? How do patients learn about it and apply?
When do patients receive cost estimates and how are they communicated? Are they in plain language?
Does your institution have a resource guide or community partners that support patients?
What are your state’s options for health coverage? If your state has yet to expand Medicaid, are there other programs that support the uninsured or underinsured?

TIP

Get to know your medical billing team – also called Revenue Cycle Management

Medical billing staff are often disconnected from clinician staff but manage financial assistance. Hospitals increasingly face challenges in collecting payments from insurers; recent data shows that 1 in 3 inpatient claims were not paid within three months and 15% of patient claims were denied in the first quarter of 2023 for commercial payers.

Additionally, patients are struggling with inadequate health insurance that requires high deductibles and out-of-pocket costs that are unaffordable. Aligning awareness and practice across these two groups will help streamline solutions that maximize good health for patients and revenue for hospitals.

Learn more about the perspectives of revenue cycle leaders by reading our research.

Learn More About the Research