I know an emergency physician who calls his patients “customers.” Every time I hear him do so, I sort of cringe inside. I have yet to ask him why he says it. He does so sometimes in a joking manner but other times says it so matter-of-fact. But he does so rather consistently going about the Emegency Department where we both work as physicians referring to many of his patients as customers especially in conversations with the nurses about the patient’s care.
Why does it bother me to hear him call patients customers? Because it reminds me of a popular fast food tag line “Have it your way,” and how in the restaurant and retail industry “the customer is always right.” Now, don’t get me wrong. I’m all about “patient first” and patient-centered care. I truly believe that I go to work each shift to serve my patients in their time of need and for me, medicine truly is a calling that I take very seriously.
But the fast food model is all about a transaction. Selling an item for money. The burger joint will give a customer a 10th hamburger to eat for lunch if that’s what he or she wants and as long as they pay for it. There is no moral obligation to the customer to do what is in their best interest. Yet as doctors, we must first “do no harm.” We must practice benevolence. We have a moral and ethical obligation to inform our patients of how their actions and lifestyle are impacting their health and wellbeing. We shouldn’t reduce ourselves to mercenaries for hire giving people things that aren’t medically necessary in return for renumeration or even positive Press-Ganey scores. We are healers, not retailers nor waiters.
Is this customer driven model something that we should have in medicine? Is the patient always right? Should the patient have it their way? Should they get antibiotics when they clearly have a viral illness? Should they have CT scans or MRIs when those tests won’t help make their diagnosis? Should they be given a work note to be off from work even though we believe they are perfectly fine to return? Each time we let them have it their way, we cheapen ourselves as a profession.
Sometimes I wonder if my colleague decided to begin using the word “customer” because of the Press-Ganey scores most hospitals use and how many hospital administrators place heavy importance on the results of these surveys. In many ways these surveys are similar to those you would see given out by retailers or restaurants. The patient surveys given ask a series of questions about their experience with their “care provider.” How friendly and courteous was your “care provider”? Their effort to include you in decisions about your treatment? Likelihood to recommend this “care provider” to others.
Where did the word “patient” come from?
While I don’t like the word “customer” let’s look deeper at the word “patient.” Where did the word “patient” come from anyway? And why have we always used the word patient as opposed to “customer?”
The word “patient” originally meant ‘one who suffers’. This English noun comes from the Latin word patiens, the present participle of the verb, patior, meaning ‘I am suffering,’ and akin to the Greek verb paskhein (to suffer) and its cognate noun pathos.
The word allows us as healers to have empathy towards our patients. To realize that when they come to us “suffering” from illness or injury we have an obligation and duty to use our knowledge and training to help alleviate their suffering regardless of their gender, creed, ethnicity, political views, or socioeconomic status. We take the Hippocratic oath and practice medicine with this in mind daily.
But retailers, businesses and corporations, what oath have they taken and what obligations or duties do they have towards their customers? For many companies, the only thing they pursue is their bottom line.
In partnership with our patients
While I’ll admit that the word “patient” is old and antiquated and sometimes implies a passive patient role and some would argue a patriarchal tone (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116090/ ), most doctors do not want their patients to be passive participants. We realize fully that there is a partnership with the patient. We educate, advise and make recommendations to our patients but recognize that ultimately it is up to them to implement them.
We always respect their autonomy as well and right to refuse what we recommend and present alternative treatment options. We do want our patients to take an active role in their own health and wellness. What happens in one or even a few brief encounters in the hospital or office cannot possibly be all encompassing. And the lifestyles people lead outside of the healthcare setting are truly what makes the biggest impact on their overall health or wellness over their lifetime.
Patients do need to take responsibility for their health and wellness. Numerous times, I have had patients come into our emergency department having heart attacks who tell me “I just went to my doctor a few months ago and all my tests were fine. How could I be having a heart attack.”
Meanwhile they lead a sedentary lifestyle, smoke and follow a poor diet and don’t manage their stress. Likely they were counseled by their doctor about the importance of quitting smoking, getting active and eating a healthy diet. Yet because lab tests were normal they took it as a clean bill of health. The routine annual tests only scratch the surface and the patient needs to take responsibility for what is happening in their day to day life. And no doctor can be there with them daily to remind them of those things as a mother would a child. Furthermore as doctors we respect the autonomy of our patients to assume that as adults (or the gaurdians of our pediatric patients) they will implement the needed changes and take responsibility for their life.
So, what do you think? Would you call your patients “customers” or “clients” or perhaps use another word? Leave a comment below.