“Customer,” “consumer,” and “provider” are words that do not belong in teaching rounds and the clinic, two Beth Israel Deaconess Medical Center physicians, Pamela Hartzband and Jerome Groopman write in a stinging attack on the “industrialization” of medicine in the latest issue of the New England Journal of Medicine.

“Customer,” “consumer,” and “provider” are words that do not belong in teaching rounds and the clinic, two Beth Israel Deaconess Medical Center physicians, Pamela Hartzband and Jerome Groopman write in a stinging attack on the “industrialization” of medicine in the latest issue of the New England Journal of Medicine.

“We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized.”

But medicine is much more than a commercial transaction, they argue.

“To be sure, there is a financial aspect to clinical care. But that is only a small part of a much larger whole, and to people who are sick, it’s the least important part. 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.”

Commercialisation will corrupt the doctor-patient relationship:

“Business is geared toward the bottom line: making money. A customer or consumer is guided by ‘caveat emptor’ — ‘let the buyer beware’ — an adversarial injunction and hardly a sentiment that fosters the atmosphere of trust so central to the relationship between doctor or nurse and patient. Reducing medicine to economics makes a mockery of the bond between the healer and the sick. “

Even more troubling, the authors suggest, is the impact of the new vocabulary on future doctors, nurses, therapists and social workers who care for patients.

“Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring.

“When we ourselves are ill, we want someone to care about us as people, not paying customers and to individualize our treatment according to our values. Despite the lip service paid to ‘patient-centered care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs.

“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.” ~ NEJM, Oct 13

Michael Cook
commercialization
doctor-patient relationship

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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