Lamenting the new medical language

By Chelsea Conaboy, Globe Staff

Don’t call them “providers.” Pamela Hartzband and Jerome Groopman are “doctors.” The people they care for are “patients,” not health care “consumers” or “customers.”

In a perspective piece published in this week’s New England Journal of Medicine, the husband and wife, both on staff at Harvard Medical School and Beth Israel Deaconess Medical Center, where Groopman is chief of experimental medicine and Hartzband is an endocrinologist, call on doctors, nurses, and others to reject the vernacular that cloaks medical care in deal-makers’ language.

“Marketplace and industrial terms may be useful to economists, but this vocabulary should not redefine our profession,” they write. “ ‘Customer,’ ‘consumer,’ and ‘provider’ are words that do not belong in teaching rounds and the clinic.”

Groopman and Hartzband point out that health care titles have remained the same for more than three centuries, born out of the Latin words patiens for suffering, docere, meaning to teach, and nutrire, to nurture. Here’s an excerpt from the piece, “The New Language of Medicine.”:

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. 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. The consumer or customer is the buyer, and the provider is the vendor or seller. 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. Furthermore, the term “provider” is deliberately and strikingly generic, designating no specific role or type or level of expertise. Each medical professional — doctor, nurse, physical therapist, social worker, and more — has specialized training and skills that are not recognized by the all-purpose term “provider,” which carries no resonance of professionalism. There is no hint of the role of doctor as teacher with special knowledge to help the patient understand the reasons for his or her malady and the possible ways of remedying it, no honoring of the work of the nurse as a nurturer with unique expertise whose close care is essential to healing. Rather, the generic term “provider” suggests that doctors and nurses and all other medical professionals are interchangeable. “Provider” also signals that care is fundamentally a prepackaged commodity on a shelf that is “provided” to the “consumer,” rather than something personalized and dynamic, crafted by skilled professionals and tailored to the individual patient.

Hartzband and Groopman go on to say that, when we are sick, we want to be seen by someone who cares about us as a person, rather than as a paying customer.

Certainly words are powerful, and many medical professionals today are worried that the intense focus on the dollars and cents of health care is eroding the patient-doctor relationship.

But this piece also raises questions for me, as someone for whom controlling my own medical costs is a priority. I favor the term “patient” over “customer” because I recognize that buying health care is -- and should remain -- a dramatically different experience than shopping for a new dress, cell phone plan, or car.

But I also want my doctor to understand that my financial health is part of my overall quality of life and to be willing to discuss with me the cost of testing and treatment, as necessary.

What do you think? Doctor and nurse, or providers? Patient or health care consumer? What titles suit you?

Is the term “patient” broad enough to include those who are concerned with or savvy about cost? Could the term “consumer” fit the full definition of someone seeking care?