Readers of Secondhand Smoke and my other writings know that I have grown increasingly concerned at the deprofessionalization of medicine. Part of this is a self deconstruction in which medical organizations and many bioethicists have reduced doctors to so many order taking technocrats with their implacable opposition to medical conscience rights.
Physicians and other health care workers are also being deprofessionalized by the engineering of the words we use to describe their roles–as in my just using the term “health care workers” instead of “medical professionals.” Some have noticed and are none too pleased. From an interesting article in the New England Journal of Medicine by Pamela Hartzband, M.D., and Jerome Groopman, M.D., entitled, “The New Language of Medicine:”
Now, we find ourselves learning anew language of medicine filled with words that seem familiar yet feel foreign. Patients are no longer patients, but rather “customers”or “consumers. Doctors and nurses have been transmuted into“providers.” These descriptors have been widely adopted in the media, medical journals, and evenon clinical rounds. Yet the termsare not synonymous. The word“patient” comes from patiens, meaning suffering or bearing an affliction. Doctor is derived from docere, meaning to teach, and nurse from nutrire, to nurture. These terms have been used for more than three centuries.
We are in the midst of an economic crisis, and efforts to reform the health care system have centered on controlling spi-raling costs. To that end, many economists and policy planners have proposed that patient care should be industrialized and stan-dardized. Hospitals and clinics should run like modern factories,and archaic terms such as doctor,nurse, and patient must therefore be replaced with terminology that fits this new order.
But that is precisely when professionalism is the most important to defend. During the occupation of the Netherlands, when the Nazis attempted to force doctors into a dual mandate of looking out for the interests of the state as well as of patients–the predicate to the euthanasia pogrom then ongoing in Germany. Dutch doctors refused, and in March 1943, engaged in civil disobedience. They took down their shingles, refused to sign birth and death certificates, and resisted every attempt to destroy their fiduciary professional obligations to their patients until the occupiers backed down. If those courageous doctors could fend off Nazis, surely today’s can stand athwart bureaucratic maneuvering and lexicon engineers!
These changes hurt medical professionals and patients:
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…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.
We believe doctors,nurses, and others engaged in care should eschew the use of such terms that demean patient and professional alike and dangerously neglect the essence of medicine.
October 31st, 2011 | 1:52 pm
The problem is two sided, patients are pressing to remind the doctor that they are ‘just’ a paid employee that provides a service the consumer (patient) desires and pays for because so many doctors have forgotten “first do no harm” and have become so tyranical and apt to brush off or ignore informed consent/refusal that patients feel they have no other choice but to try to force doctor/patient care into an employer/employee relationship between a ‘provider’ and a ‘consumer’. A provider has to do what the consumer says (within the bounds of the provider/consumer relationship). While I’m sure what you are talking about figures into it, the people I know what talk about ‘medical personell’, ‘providers’, and ‘health care workers’ all do so in a desperate attempt to control a situation that is out of control. Not a finacial one but a trust one. When doctors not only provide but push for abortions, demand unnecessary procedures, override consent, talk about ‘futile care’, and advocate for ‘assisted suicide’, I contend they no longer *are* doctors, they are just another ‘worker’ more concerned with a paycheck then a patient.
Now I’ve known some really stellar doctors, and I’ve also known more than one that didn’t deserve to stand in the shadow of a real doctor, much less use the honor and trust that white coat provides to bully their patients.
October 31st, 2011 | 2:54 pm
I don’t think becoming a technocrat will keep them from having a fiduciary relationship. They’ll be told what to do, treated as order takers, but the system will still demand that they be responsible. They’ll be responsible without having authority to to be responsible. When we were fighting a bill to compel pharmacists to fill abortifacient pills against their morals, one of the NV Senators said in so many words, if they won’t do it, they can go sell shoes. Selling shoes if an honorable profession, but the senator was telling Pharmacists they could get lost if they would not violate their consciences. We are over 80,000 pharmacits short in America. They are just bullies. Doing this demeans and harms to doctor, nurse, pharmacist and other medical professionals. It takes away part of their humanity by violating their consciences. Conscience objections are okay for those who are PC, but not for pro-life, pro-family doctors. What a bunch of frauds.
October 31st, 2011 | 8:43 pm
They’ll be responsible without having authority to to be responsible
Yes, but in equal measure, there will be others – probably with no medical training at all – who’ll have authority without having to take the responsibility.
Was there ever a left wing idea that didn’t, in the end, end up being about breaking the link between responsibility and authority?
November 1st, 2011 | 7:00 am
Technology while it is a marvelous tool has reduced humans to mere team members. Gradually the ability to diagnose is being replaced by a computer. Sensitivity, the basis for all dramatic excellence is cast aside in favor of intuitive mechanism. Artistry in all fields will soon dissapear. Seems we threw out the baby with the bath water when we left the Picean age of sensitivity and entered the Aquarian age of universality. Teams are average producers, and there is no allowance for individual exceptional performance. Where would Einstein go for answers today? Where is the wonder? I want to take my laptop and go back.
Wesley J. Smith Reply:
November 1st, 2011 at 9:59 am
Welcome Shirley!
Alice Robertson Reply:
November 1st, 2011 at 5:05 pm
@Shirley Willey, Ha! If
Einstein had just had a laptop to data crunch:). Now they claim
Einstein was wrong. Are we not all genius now that the world is at our fingertips?
My daughter has cancer (our second child with cancer), so the future of medicine captivates me. I sent this post to my doctor friend, and my med student friend. They both thought it was thought provoking….actually…I am a secret admirer of Dr. Groopman….oops….oh well….surely, the world knows he is absolutely dreamy! Ha! Smart and empathetic…oh…it’s just….ah be still my heart….:)
I am glad doctors are morphing….yet we are currently caught up in a departmental tug of war at the Cleveland Clinic. I really dislike bully-pit patients….yet….I understand them at a level I wish I didn’t. I write….I beg…try to discuss why we are waiting….doctors are as much a victim of their colleagues than any other sources and on several levels. They are puppets of Chairs, Directors, insurers, and government and now patients who could once be muted are screaming for individuality and full disclosure…yeah…it’s a hard job….but their predecessors left a legacy of corruption and muteness that needed addressed…..they are victims of the breeding of arrogance they could innoculate against….patients grew stronger….but I hope we not follow the same slippery path lest we too find ourselves victims of our own arrogances.
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