Note: I wrote this guest post for KevinMD.com and it generated a fair number of comments.
I’ve been hearing and reading a lot lately about how the doctor-patient relationship is under siege. There are many reasons for this, ranging from care decisions increasingly being made by insurers to the shortage of primary care physicians, to patient empowerment. I didn’t quite understand how patient empowerment could be a threat, until I started thinking about the recent perceptual shift from patients to health-care consumers.
I agree with the consumer definition, but only up to a point. I live in a large enough population center that I can shop around until I find a doctor I like. But for me, that’s where the consumer metaphor ends. We may consume health care services, but it’s nothing like purchasing a car or a sofa.
Yet people increasingly seem to think it is. They think doctors should be the equivalent of a 24-hour shopping website, at our beck and call whenever the mood strikes because as we all know, instant gratification takes too long. They should be available by e-mail and Facebook and texting and if they are not, they are not providing good customer service, as one blog commenter recently said.
Well, I’m sorry but that point of view is what my dad would call “horse manure.” I had four remarkable doctors—my family doctor, general surgeon, oncologist and plastic surgeon—guide me through five surgeries for early stage breast cancer. Not once did I feel like I was receiving poor “customer service” because I couldn’t reach them by e-mail.
Now, I do agree that we shouldn’t be so blinded by the white coats that we don’t ask questions when we don’t understand a medical term, or when we want to know why a doctor recommends a certain course of action. (And if a doctor sees your questions as an insult, then yes, you should make like a consumer and take your business somewhere else. The good ones welcome your questions and respect your concerns.) But being assertive is an order of magnitude removed from demanding a drug or treatment because we read something on the internet, or thinking it’s okay to take a phone call in the middle of a consultation. The very clear message is that we don’t value their time or considerable skills.
Speaking of skills, I’d really like to know where you get off treating someone who spends at least 11 years in training as the hired help. This arrogant viewpoint can only erode trust, the linchpin of the doctor-patient relationship. My family doctor told me that the word “doctor “comes from the Greek for “teacher,” and that teaching is a large part of what they do. I can vouch for that, as he was my breast cancer sherpa. I never could have gotten through this experience without him. Because I trusted him, I trusted the specialists he referred me to. And because I trusted them, I trusted their surgical and staff teams. See how that works? I’m happy to report that my trust was well-placed.
I’m also happy to consider myself their patient. Maybe the word “patient” has become equated with “subservient” in some circles, but I’m not buying it. I see no power struggles here. To me, being a patient means I’m in the care of people who have committed themselves to healing and helping others. What could possibly be wrong with that? Nothing, unless I see my almighty consumer self as the center of the universe, and doctors as just another set of sales clerks.
So please, unless you see me at the mall shopping for shoes, don’t call me a consumer.