“First, do no harm” is a well-established mantra of the medical profession, but it may need to be reconceptualized in an era of unsustainable health care spending. Medical bills are now a leading cause of financial harm1 and physicians decide what goes on the bill. The possible consequential harm is substantial, often leading to lost homes and depleted savings.1 While the Affordable Care Act will ensure expanded coverage, newly insured Americans will not necessarily be immune from increased costs of their care. More Americans than ever before are enrolled in high-deductible insurance plans, meaning that seemingly simple decisions that physicians make about testing could directly lead to thousands of dollars in out-of-pocket costs.1 This strain on household budgets can cause further erosion of personal health. Lack of money to pay for medical bills and medications has consistently topped the list of financial concerns for Americans on the monthly Consumer ReportsIndex survey, in many cases leading patients to postpone or forgo needed care. /.../