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The words we use can have a big impact for both physicians and patients
The New England Journal of Medicine laments that, “Patients are no longer patients, but rather ‘customers’ or ‘consumers.’ Doctors and nurses have been transmuted into ‘providers.’” Words are indeed powerful. By reducing the physician to a “health care provider,” the time-honored paradigm of medicine as a healing art is reduced to little more than commodity fulfillment.
Have we brought this paradigm shift upon ourselves or is the language in some sense an attempt to bring health care practitioners into line; a subtle way of downplaying the importance of the individual practitioner in favor of the relative security and ill-conceived assumption that one size fits all?
There is, of course, some value in algorithms—they form a roadmap leading to the correct diagnosis for which the correct pharmaceutical drug has already been determined. Notice that the point is not treating the patient who carries the diagnosis, nor is the point to look for underlying causes such as inflammation, nutritional deficiency or dysfunctional thinking. The goal in the current paradigm of medicine is arriving at a diagnosis and finding the appropriate drug with which to treat it.
The entire medical profession becomes irrelevant in the delivery of “disease management” health care. There is no need to think or to use our intuition gained from clinical experience. All we have to do is connect the dots, and it is not necessary to attend medical school for 24 years to learn how to connect dots.
The word doctor comes from the Latin docere, meaning to teach; nurse comes from the Latin nutrire, meaning to nurture or care for. Our patients are not consumers of health care. They are individual human beings who suffer, who need to be cared for, and who come to our offices in an effort to learn how to extricate themselves from their suffering.
Are we, as doctors, willing to accept the limitations imposed upon us by our medical associations with their practice parameters; by insurance companies that pay us 30 cents on the dollar; by hospital administrators who need to put us into a predictable box and reward us for doing the least amount of testing possible?
Simple tweaking of the current system is not likely to lead to a satisfactory solution to the current health care dilemma. Sometimes we need to change directions and take a new road in order to continue our journey. We are the travel guides, illuminating the path. It is our responsibility as teachers to learn everything that we can learn, so that we can offer our patients more options. It is our patients’ responsibility to take in all the information available and make the choices that resonate with them. As teachers, we have enormous freedom. As “providers,” we are very much limited by the rule of those who write our paychecks. As teachers, the world is our oyster.
We can choose to be victims, saying, “Oh, the doctor told me to take this pill/have this surgery.” We can choose to hope we won’t get the nasty side effects. It is a real shame that we have no more immune system, or hair, or strength to move around, but at least we followed the rules; what happens to us is not our fault, because we did all the “right” things. We can also choose to be active, or even proactive, on our own behalf. This particular path is more narrow and rocky than we might wish, but it also gives us the opportunity to examine the rocks and to find beauty in the path.
For physicians, this narrow, rocky path involves swimming against the stream of convention and attending conferences and seminars to learn about the latest research. Our responsibility is to be discriminating in what we choose to apply with our own patients; to ensure that whatever we do does no harm, as our Hippocratic Oath commands, and is in accordance with the best evidence available to us.
This sometimes brings us into conflict with our medical boards. We may have to defend ourselves against those who think that “detoxification” is a bad word, invented to fleece the public of their hard-earned dollars; that there is no problem with genetically modified foods; and that a calorie is a calorie, no matter what the source.
For patients, our requirement is to weigh the evidence and go with what makes the most sense to us, although this sometimes brings us into conflict with both families and other doctors.There are no absolute rules.There is no growth without conflict; no strength without resistance.
The hardest part for many of us is simply becoming aware that there are other, legitimate paths to wellness. If we truly admit that there might be another way to practice the care of health, then we are required to reexamine everything we have been taught and everything we learned in our professional schools.
For physicians, this means stepping outside the box, going beyond practice parameters and taking more time with our patients. We may no longer be paid even a survival wage by our patients’ insurance companies, because we cannot fit the six-minute patient visit into this economic model. We may be brought before our medical boards to defend our treatments to a group of physicians who are firmly committed to the symptom/diagnosis/drug paradigm.
We choose the paradigm. We can vote with our minds and our feet.
Martha M. Grout, M.D., M.D.(H) is medical director of the Arizona Center for Advanced Medicine, in Scottsdale. For more information call 480-240-2600 or visit ArizonaAdvancedMedicine.com.
