influence of patient costs and requests on emergency physician decisionmaking study objectives we examine emergency physician knowledge of attitudes about and responses to patient costsharing in the emergency department edmethods a convenience sample of emergency physicians from an integrated delivery system completed a questionnaire including selfreport questions about knowledge of and attitudes about costsharing and an experimental vignette the vignette describes a patient with an uncomplicated asthma exacerbation with a version in which she has a 100 ed visit copayment and a version in which she does not subjects responded with their best judgment of whether they would order a chest radiograph and their decision after specific patient request we examined the frequency of responses overall and associated characteristics with chi2 testingresults of 204 respondents 349 eligible participants 58 203 answered the vignette questions no respondent reported that ordering a radiograph was clinically appropriate however 85 reported that they would order a radiograph if the patient requested it there were no significant differences in the percentage of physicians ordering the test across the 2 versions overall 77 of respondents reported having limited awareness of an individual patients costsharing level 67 reported that patient costs sometimes affect their clinical decisions only 10 estimated changing their decisions in greater than 20 of encounters in which the costsharing level was knownconclusion emergency physicians are usually not aware of a patients costsharing level and in instances which they are report that this knowledge rarely affects their clinical decisions however emergency physicians are responsive to patient requests even when the treatment request differs from their clinical judgment