NEJM: Shift from 'patient' to 'consumer' undermines medicine

Medical terminology since the age of healthcare reform has shifted from a vocabulary such as vasospasms and angina to an entirely new language that turns patients into “customers” or “consumers” and doctors into "providers," according to a perspective published Oct. 13 in the New England Journal of Medicine.

“What precipitated the increasing usage of this new vocabulary in medicine?” asked Pamela I. Hartzband, MD, and Jerome E. Groopman, MD, of the Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, in the perspective. “We are in the midst of an economic crisis, and efforts to reform the healthcare system have centered on controlling spiraling costs.”

Because of healthcare reform, policy planners have suggested that patient care be “industrialized” and “standardized,” offering that hospitals should be run like factories and “archaic terms” such as doctor, nurse and patient should be replaced with newer terminologies such as “provider” and “consumer.”

“The words we use to explain our roles are powerful. They set expectations and shape behavior. This change in the language of medicine has important and deleterious consequences,” Hartzband and Groopman wrote. “The relationships between doctors, nurses or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction.”

Today, the patient is the buyer and the physician is the seller. While Hartzband and Groopman agree that there is a financial aspect to medical care, they noted that this portion is small and care should instead be focused on caring for the sick.

“The words ‘consumer’ and ‘provider’ are reductionist; they ignore the essential psychological, spiritual and humanistic dimensions of the relationship—the aspects that traditionally made medicine a ‘calling,’ in which altruism overshadowed personal gain,” the authors wrote.

Hartzband and Groopman offered that the word “provider” gives a sense that care is “fundamentally a prepackaged commodity on a shelf that is ‘provided’ to the ‘consumer,’” rather than something tailored to the individual patient.

“Reducing medicine to economics makes a mockery of the bond between the healer and the sick,” the authors scorned.  “Should we now be celebrating the doctor whose practice, like a successful business, maximizes profits from ‘customers’?”

But what impact will the new vocabulary have on the future generation of doctors and nurses? These types of buzzwords have the potential to weaken professionalism, Hartzband and Groopman added.

"We believe doctors, nurses and others engaged in care should eschew the use of such terms that demean patients and professionals alike and dangerously neglect the essence of medicine."