A few months ago, I had the privilege of serving as the keynote speaker for an excellent conference in Boston. "Empowering Healthcare Consumers: a Community Conversation" brought together an impressive array of people to discuss how to improve health care through empowerment. In attendance were more than 150 community leaders, clinicians, hospital administrators, insurers, advocacy group leaders and patients.
Patients -- or do I mean health care consumers? The conference organizers specifically requested that I use the term "health care consumer" rather than "patient" in my presentation. Several of the speakers before me made the point eloquently as to why. "Patient" has the connotation of passivity, and people need to be active to take charge of their health. We need to be savvy consumers and do our own research into the cost and quality of health care, much the same way we would if we were shopping for a new car.
The new language made me uneasy. Don't get me wrong. I am all for people being empowered in their health care (I write a blog and published a book on this) and for transparency and availability of information to make informed choices. However, I also believe that health care is a human right. A patient deserves health care as a right. But does a consumer?
Those of us in favor of universal access to care argue that health care is not a commodity like cars and TVs. Referring to people as consumers could undermine this fundamental tenet. If you are shopping for health care in the same way you shop for your car or TV, this implies that you buy what you can. (Can't afford a new Lexus? Buy a used Toyota. Maybe wait a year.) This doesn't -- and shouldn't -- work for health care. (Need heart surgery? Choosing the "discount" surgeon, or waiting a year, don't sound like good choices.) Those who can't afford health care are priced out of it, and health care is no longer a public good, like public education and clean water.
I also worry about effects of rebranding on the physician-patient relationship. What happens when the doctor becomes the hired consultant of the savvy shopper patient? Perhaps the doctor will be more responsive to consumer demands -- but perhaps this doctor will also feel more obligated to give the consumer exactly what she wants, including unnecessary tests and harmful procedures. And will these physicians still retain their sense of social responsibility when health care is reduced from societal obligation to personal choice?
An extreme version of patient-as-consumer can be found in China, where people routinely pay their doctors under the table as a promise to receive better care, and patients -- even those dying of stroke and heart attack -- are turned away from hospitals if they cannot pay up front for their treatments. The physician-patient relationship has broken down so much that doctors have been murdered by angry patients' families.
In such a system, where it's every woman for herself, it's hard to convince people that health care is something we all have to safeguard. We already live in a society where many believe that more is better -- at least when it comes to ourselves. When making health care decisions, few take into account the cost to society. Yet, health care is not a limitless commodity. There are efforts underway to think of the escalating cost of health care as we do global warming, but these efforts will not work if we adopt the language of consumerism.
So what is to be done? Here's a suggestion. Instead of throwing out the word "patient," change what it means. Encourage people to become the educated, empowered patient, even, dare I say, the pushy patient. This is the patient who will make individualized choices about her health as an active and equal partner with her doctor. This is the patient who will ensure the best possible care for herself and, in so doing, catalyze reform of our health care system to one that values informed decision-making and reaffirms health as a basic right.
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