You can’t go to a conference or read a health care industry think piece today without noticing a suspicious lack of “patients” in our language; it seems they have all been replaced with a new kind of person in healthcare: the “consumer.” Savvy, demanding, and armed with Google search results, these former-patients are now at the heart of every sales pitch for the new way to improve care delivery. These rebranded patients are the impetus behind improving customer service, making prices more transparent, building apps to allow for on-the-go care, and a head-spinning amount of new advertisements. But less than a decade ago, this kind of talk about “consumers” in healthcare was scandalous.

“When I talked about the importance of our treating our patients as customers on my first day on the job, the reaction I got made me think it would be my last day as well,” recalls Sven Gierlinger, the Chief Patient Experience Officer of Northwell Health. Gierlinger, who was leading patient experience for the Henry Ford Health system at the time of this chilly reception, points out how critical it was to use language from the hospitality industry to shake up the thinking of healthcare executives. 

That need to redefine the old paternalistic relationship between doctor and patient is no small task. In a recent conversation with Egor Safrygin, the Chief Digital Transformation Officer of a private hospital in Russia, he explained that the tradition of the doctor as a god in a lab coat was still very much at the heart of care delivery there. Patients are seen as passive bodies come to the good doctor for diagnosis and a prescription. But “customers” have power. “Clients” can choose where they go for care. A new focus on “healthcare consumerism” at this hospital keeps the patient’s opinions, wants and needs front and center during a course of care. And for a private hospital that caters to the very wealthy, this customer-centricity is expected with the premium price for care. 

So the language of the hospitality and retail sectors has been an important tool in pushing for patient-centric practices and a more humane approach to care delivery. In the most generous reading of the term, “healthcare consumerism” means that patients have a greater ability to research their care options and make active and informed decisions about their care—and, therefore, where to spend their money. The digital age has certainly brought about a revolution in patient education and activism, however, shared decision making and patient-centered care are concepts that have been around since the 70’s. Born out of the patients rights movement, these concepts became cornerstones of moral and ethical debates about how the doctor and patient relationship should evolve and modernize. But often these efforts were “nice to have” programs that were unable to meaningfully quantify their impact to the business of medicine. 

To a certain extent, rebranding “patient centered care” to “healthcare consumerism” has helped to quantify the real financial power that patients possess. For too long, the “customers” of healthcare services were seen as the insurance companies. The patients themselves were no more than the table upon which payers and providers could dig in their elbows and arm wrestle each other for dollars. This move towards the patients as “customers,” coupled with the rise of insurance plans that force people to pay for more of their care out of pocket, can be seen as a kind of patient empowerment. 

But what does it do to our thinking, and our approach to problem solving, when we substitute in the language of commerce for the language of care? The better question to ask is: When we call our patients “customers,” what have we lost?

So much of modern healthcare has been reduced to the cold calculations of the marketplace. But perhaps medicine, like other crucial services, is about an exchange of such essential value that it is obscene to define in commercial terms. Think about a mother and a new born baby, or a fireman coming to the scene of a car accident. In both cases, one person is in such a state of need that it would be wildly inappropriate to think of them with the same kind of active choice a “consumer” might have. And the person providing the “service” is doing so despite the fact that they can never truly be compensated for the magnitude of the care they give. 

The parent, the fireman, the nurse—they get a paycheck (or an “I love you daddy!”), but it’s generally not why they chose to take on their role. Instead, the service or care they provide is a calling, a life’s purpose and a way of giving back. To define this relationship in purely commercial terms is to mischaracterize it. 

Now let’s take patient’s perspective in this dynamic: when you’re sick, you're not really your best “consumer” self. People are often scared, overwhelmed and in pain when they seek out medical care. Doctors and nurses have specialized knowledge and access to treatments that no amount of googling could ever match. Insurance often limits which providers you can see “in network” and for folks in rural areas, there may only be one doctor in town. Is it truly a marketplace when the “buyers” are starting at such a clear disadvantage? We ignore power dynamics at our own peril. As Dr. KrisEmily McCrory so eloquently put it, “Within the very nature of a physician patient relationship there is an undeniable level of inequality. Referring to patients as clients (or consumers) does not remove that imbalance of power. Rather, it only serves to gloss over it.” 

It comes down to this: To change our language from “patients” to “consumers” is to take a dynamic of care and rebrand it as dynamic of commerce. Everyone involved is stripped of their worth as humans, and instead are given back their value as buyers and sellers. Consumers don’t suffer. Consumers don’t need emotional support. Consumers are to be catered to, so long as it keeps them coming back for more services. But when you talk about someone as a “patient,” it's hard to shake off the image of the sick and frightened person that sits shivering in a paper gown in need of care. We used the language of consumerism to shake up our thinking about patient experience and tie its impact to real value. But this language also removes from the patient the power to tug at our hearts, so that we can focus instead on what tugs at our purse strings. 

Consumerism values people for the dollars they control. Healthcare — the true administering of care, not the healthcare system as we’ve come to know it — values people because they are people. Try to imagine if the fire department started calling the people it served “consumers.” Or if a priest refers to parishioners as “customers.” Words are powerful. The wrong ones hurt. The right ones can help. We need new words to pull us all — doctors, patients, health plan administrators, insurers, and everyone who is part of giving and receiving healthcare in this country - back to the business of being human. 

Photo by Hush Naidoo on Unsplash