What is a Patient?

What is a patient?  What do they do?  What’s their role in the doctor’s office?  Are they chassis on a conveyor belt?  Are they puzzles for doctors to solve?  Are they diseases?  Are they demographics?  Are they a repository for applied science?

Or are they consumers?  Are they paying customers?  Are they the ones in charge?  Are they employing physicians for their own needs?

It depends.  It depends on the situation.  It depends on perspective.

Some physicians are very offended when the “consumer” and “customer” labels are applied to patients.  They see this as the industrialization of healthcare.  We are no longer professionals, we are made into “providers” – a sort of smart vending-machine made out of flesh.

Patients, on the other hand, get offended when doctors forget who pays the bill.  They see the exam room as a right, not a privilege.  They think they should be the most important person in the exam room, being treated with respect rather than having to bow at the altar of doctor knowledge.

Who is right?

It depends.

My perspective in my practice has been shaped over the 16 years of being in medicine.  It has been shaped by the fact that patients have paid my salary.  It has been shaped by the fact that they can choose to leave my practice any time they want.  I have to give them good medicine, but I also have to work for their business.  I am not talking about practicing bad medicine so that they stay with me, I am talking about everything else about the doctor visit.  So what are the roles in the doctor’s office?  Here’s my perspective:

1. I run a business – I have to pay the rent, pay my staff, pay for immunizations, and (hopefully) have money left for me.  This means that efficiency is king.  If I don’t run the business well, I end up not being able to practice medicine.  On the other hand, the better I run the business, the more chance I have to slow down because the cash-flow gun is not held to my head.  The patient in this case is my customer.

2. I treat a bunch of patients – One of the things that prevents pandering to the demanding patients is the fact that I am interested in the care of all of my patients. If I let one person dominate my time or demand to be seen, it will hurt my other patients.  The patient is the center of the universe of our office, but I mean “patient” in the global sense; it is not a single patient, but the care of our entire patient population.  The patient in this case, is a consumer – one of a group of people using the service I render.

3. They pay me for my expertise – I am a medical doctor who they are consulting for my opinion based on my training.  They are not seeing me “to get a prescription” or “to have tests ordered.”  There are times when it ends up looking like this, but it is always my obligation to give them the best medical care possible.  Sometimes that means that I don’t give people antibiotics and don’t order tests that they want.  The patient in this case is a patient – a person receiving medical care.

4.  I am not God – I don’t know all.  I don’t sit on a higher chair than my patients.  I have knowledge about medicine and a ton of experience.  They have just as much life-experience as I do, and they know their own bodies better than me.  The whole encounter is about fusing that knowledge together and coming with a plan from both sets of knowledge.  My patients are not idiots, and so I need to listen to them.  I expect them to listen to what I say only after I have listened to what they say.  The patient in this case is a participant in their care.

5. It’s their choice in the end – Patients don’t have to follow my advice.  They don’t have to check their sugars or lose weight.  They don’t have to stop smoking or get tests done that I order.  My job is not to make them do that, it is simply to point them in the direction that I think is best for them.  I should not take offense when they don’t do as I say; I should instead look to make sure the cause of noncompliance is not poor communication on my part.  The patient in this case is autonomous.

6.  I am giving care, not practicing science – In the end, I am a caretaker.  I don’t cure everyone.  All of my patients eventually die.  I work to relive pain, I try to help people avoid preventable problems.  I also sit at their side when they suffer, offering companionship, not expertise.  I have a unique opportunity: people build a relationship with me based on their pain and their need.  In this case the patient is a human being.

I am not sure why people bristle at calling patients consumers; that’s what they are.  They are also customers, participants, autonomous, and humans in need.  This is not an “or” proposition.  If we forget the humanity of patients and just treat them as customers, they lose.  But they also lose if we forget that they are paying us and demand our respect and our attention to their needs.  We are as much servants as we are professionals.  Signing up to be a doctor means you agree to give yourself to your patients.  All of them.  It’s hard, and it’s complicated.  It’s a human-human relationship.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

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