All I want for Christmas is to be a physician, not a provider and to have more patients and fewer healthcare consumers. Consumers is such a harsh word; it’s all about taking, at best knowledgeable choosing. And with its roots in economic analysis, in supply and demand, it makes me, unwillingly, a provider; replacing bedside manner with an assembly line facelessness, an easy substitutability.
The words, consumer, provider, reverse more than flatten the asymmetric power relationship between physician and patient. Physicians, for a long time, were too paternalistic. You never heard a physician described as too maternalistic, perhaps the connotation of mothering is more comforting than smothering. It is true that physicians tend to be so imbued with their knowledge, that doubt rarely creeps in. And back in the day, perhaps more patients were comforted with a paternalistic presentation, especially when choices were few and not particularly helpful. Then paternalism might be conflated with hope.
But, calling the patient ‘consumer’ has other implications. It reduces physicians to knowledgeable salespeople, thoughtfully helping you select the proper diagnosis and treatment. More importantly, being a consumer creates an unrecognized responsibility, to have enough knowledge to clearly articulate their problems and needs. This is a difficult task for physicians with years of dedicated their training; it is an impossible burden for a patient, especially when fear or anxiety accompany their concerns.
Consumers easily replace providers, you just choose another, after all, providers are all the same. Is that how a ‘healing relationship’ appears? The physician-patient relationship is about shared vulnerability. The vulnerability of the patient to stand before you, admittedly with less power and control, exposing physical loss and psychic uncertainty. The physician is also vulnerable, entrusted with something of inestimable value to another, and uncertain that they can make it better, let alone, heal.
Consumers have wants, serviced by providers. Being a patient is the ability to trust that your vulnerability will be acknowledged and respected. Being a physician is to recognize you are being entrusted with need, not desire, and to act as a servant to those needs. In an aspirational way, physicians are ‘servant-leaders,’ Called initially to serve, to nurture and care and then trained to lead. Robert Greenleaf who catalyzed the concept of ‘servant leader’ in the mid 50’s describes them making sure
“…that other people’s highest priority needs are being served. The best test, and difficult to administer, is: Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?“
Medical economics defines episodes of care, but the relationship between patient and physician, with its vulnerability, takes longer to establish; it is about continuity, not substitution. Physicians, as servant leaders have less control, they nudge rather than order. Patients are held on a higher level, being served and sharing in decisions. Consumers only make bad choices; providers offer inadequate solutions, there is no accountability on either end of that bargain. Words matter. It is time to restore healthcare consumers to the rightful place, honored as patients. It is time to allow providers once again to answer their calling and be physicians.