Sometimes prospective new patients ask me over the phone, “Are you a medical provider?” or “Are you a provider for [name of their particular health insurer]?” And that gets me started.
Provider. Such a generic and seemingly inoffensive noun, and yet it repels me. To me, it is the verbal equivalent of a hair ball my cat barfs onto my pillow. And so I feel obliged to clean it up by correcting, as courteously as my gritted teeth permit, the person who uttered it. “No,” I say, “I am a physician.”
Well, excuse me! What’s the big deal? It’s just a word, right? Wrong. Transcending its mere lexicographic significance, the use of provider within a medical context conveys an attitude that perpetuates the dysfunction of our health care system.
Let’s examine the term. It refers to an individual or group that gives something to other individuals or groups. There are television news providers and corporate providers of iPhones and Cheez Doodles. Your local pushers provide street drugs. Mob bosses provide “protection.” Providers of entertainment abound: film studios, Disney World, strip clubs. Speaking of which, I have seen sex workers referred to as providers. I and my family provide each other with love and sometimes material gifts. I provide my cats with food and a clean litter box, and they in turn provide me with feigned affection. They provide each other with company and mutual grooming of their private parts. And so on.
Insurance companies may also label me a vendor. They, some public health agencies, and patients’ rights organizations refer to patients as consumers. These terms, with provider the most prevalent, reflect the commodification and commercialization of health care. Such terminology suggests a correspondence between a medical appointment and a visit to Walmart to purchase socks.
The use of provider in medical settings dishonors and betrays what traditionally has been and should be the human, and humanistic, core of medical care. Unlike your auto’s attendant at Jiffy Lube, your clerk at the minimart, or the corporation that creates your computer (however decent and meritorious these other providers may be), physicians engage with patients in a specific kind of fiduciary relationship governed by ethical imperatives — confidentiality, respect for boundaries, non-exploitation; the principle of “first do no harm”; the expectation of caring attention, etc. — that one finds to the same degree and number in few other professions.
Would you call your priest or rabbi your religious provider? Your attorney your legal provider? Or your college professor your lecture provider? Of course not.
So why has provider gained such prominence in health care? Most physicians, I believe, dislike it. Patients, I think, still prefer to consider professionals for whom they shed their secrets and their clothes as physicians or doctors and not providers or vendors.
However, insurance companies, HMOs, government, and large clinics and hospitals find provider useful, for it dehumanizes both physicians and patients, morphing them into fungible and malleable corporate widgets. As such, physicians increasingly have had to compromise their ideals in order to practice within 15-minutes-per-patient (or even shorter) appointment boxes as they maximize the bottom lines of their paymasters. They have little time to talk with patients, and less in which to understand them as people. In short, the word provider transforms physicians from healers into organization men and women.
Might it be useful for the medical profession to reflect upon such terms that redefine its identity? Might this reflection alter our practices to the benefit of ourselves and our patients? Perhaps, but right now I need to find some paper towels, for my cat is retching again.
Steven Goldsmith is a physician who blogs at his self-titled site, Steven Goldsmith.
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