Financial Toxicity, Swift Trust, and the Future of Cardiology

A commentary by Dr. Emil Lou on Medscape discusses financial toxicity and patient trust. This is the first time I have encountered these two terms, which I found particularly striking: financial toxicity and swift trust.

The oncology perspective in the commentary made the issue especially clear. Cancer patients often face prolonged treatment journeys with substantial financial consequences. Financial toxicity can therefore become part of the patient’s experience of illness, while the first encounters with the oncologist may determine how quickly trust is established.

This made me think about our patients in cardiology. Our speciality is becoming increasingly expensive. Advanced imaging, coronary intervention, structural heart procedures, TAVI, devices, and long-term cardiovascular therapies can all carry substantial costs.

At the same time, healthcare systems in many parts of the world are moving, to varying degrees, from predominantly public models toward private or mixed healthcare systems.

This transition may create a new challenge for the doctor-patient relationship. When a cardiologist recommends an expensive investigation or intervention, the patient may naturally ask: “Is this recommended because I truly need it, or because there is a financial incentive to do it?” The physician may have completely appropriate clinical reasons. Yet the perception of financial conflict can still affect trust. This is where swift trust becomes important.

In many consultations, particularly the first one or two encounters, the doctor has very little time to establish credibility. The patient is deciding whether the recommendations are genuinely centred on their health. Financial toxicity can threaten that trust very quickly. We should therefore become more comfortable discussing cost with our patients.

Asking, “Will the cost of this treatment or investigation be a problem for you?” should not be seen as compromising medical care. It may be an essential part of understanding whether the proposed treatment is actually feasible. This does not mean choosing cheaper medicine when better treatment is indicated. It means being transparent about alternatives, benefits, risks, and costs.

As cardiology becomes more sophisticated and healthcare systems become more financially complex, protecting trust may become as important as choosing the right investigation or intervention.

I had never thought of the doctor-patient relationship through the concepts of financial toxicity and swift trust before seeing this commentary.

Trust can take years to build, but in a modern healthcare system, it may take only one expensive recommendation to make a patient question it.