THCB

Stop Calling Them Patients!

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We have a healthcare system that is provider-centric indeed.  Why else would we call the consumers of their services “patients?”  Perhaps because they have to be patient.  Patient because they have to wait long after their appointed hour to be seen.  Patient while waiting in the Emergency Room.  Patient because the healthcare system is rigidly resistent to change.  Patient because even the most advanced providers measure quality based on “best practices” rather than outcomes.  Do you care about whether your physician employed best practices if your outcome was bad?  Ummm, nooo.

So let’s rename patients right now.  How about “consumers?”  For sure they are, although in today’s dysfunctional healthcare “system,” they rarely pay the providers whose care they consume.  But let us not hesitate over that anomalie, which may be slowly changing.  Up to now, we as consumers of healthcare rarely even choose our providers.  They are chosen for us by other providers.  And if we want to be good shoppers and choose ourselves?  How do we do that when we cannot determine how much a provider costs or how good he or she is?

Oliver Wyman’s Tom Main and Adrian Slywotzky got it right when they opened their superb article with the following observation:

“For many people, the word “consumer” sounds out of place in a discussion of healthcare.  And indeed some of the woes of our system arise precisely from our (mostly ineffective) effort to keep commerce away from medicine.  We thought we were protecting the autonomy of physicians, but inadvertently we created a system that rewards waste and failure and makes it difficult to deliver optimal care. 

We need to flip that around and create a healthcare market that rewards success and penalizes failure, where no one benefits unless the patient does, and in which competition leads to falling costs and rising quality.  That is not just a business aspiration but a cultural and ethical one as well, and it recognizes both the ambitions of healthcare professionals and the centrality of health in all our lives.”  The Patient-To-consumer Revolution, p. 7.

What about this strikes you as right or wrong?  My premise is that we ban the word “patient.”  It is demeaning and represents all that is wrong with our healthcare system today, which is of poor quality, costs entirely too much, and virtually ignores the, ummm, consumer.  Will you join me?

Jim Purcell is the former CEO of Blue Cross & Blue Shield of RI. He now helps large employers cultivate workplace wellness strategies that reduce premiums and increase productivity. Learn more at jamesepurcell.com.

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32 replies »

  1. I can’t help wondering what responsibility the patient has as a consumer. Though the onus is clearly on the physicians and other medical professionals to determine care, they are still mere mortals, and would be better equipped to serve “customers” if more information were provided. Electronic record keeping is a HUGE stride in eliminating waste and putting care of your body back in your hands – should you choose to. Unless you are up in all preventative testing, fit, and managing any conditions you have to the fullest, and reporting every pattern of symptoms you may have to your doctor, how can you expect wasteful spending on your behalf?
    http://www.lmtpoet.blogspot.com/2014/10/gallbladders-healthcare-and-hospitals.html?m=1

  2. For those who have commented, mostly negative, I DO appreciate the comments and will consider them as thoughts develop.

  3. I’ll stop using the work “patient” and adopt “consumer” when my health insurance allows me to make decisions about my care-givers rather than dictating them through a fee structure designed to support their bottom line rather than my health.

  4. Hey, hmmm… maybe we can “cultivate workplace wellness” by not calling workers “employees”? How about “associates”?

    Oh, wait… 😉

    Maybe we could ask Vik Khanna about it.

  5. Ya Bobby, BCBS’s “consumer” treatment was the reason I turned their premiums into my own health savings and became uninsured self pay. I accumulated a bunch of rainy day fund and am now in Medicare, and so far it’s great.

  6. Great, Bobby.
    You can’t take a completely disfigured “market” and call parts of it pleasing names like “consumer” without causing the trench workers, and the public, to wretch.

    Truth in names:

    We should be calling insurers “rationers” because they decide which claims to pay.
    We should be calling plans ” monopsonies” because they are often the only purchasers in an area that can buy hospital or professional services.
    We should be calling doctors who have sold their practices to the hospital: patient ===> now hospital agents….PnHAs.

  7. I see that Jim Purcell is an ex BCBS CEO. My experience with BCBS of NC was never one where BCBS ever treated the patient/consumer as anything but a profit/bonus liability.

    BCBS rewarded its executives, not on achieving a better definition of “patient”, but on fixing the bottom line against premium payers and toward disgustingly inflated bonuses, while “consumers” premiums went up – not down as he advocates for every one else in the industry.

  8. “in which competition leads to falling costs and rising quality.”

    This will never happen in health care. It can happen selling stuff because the potential to sell more stuff is real – do we want to sell more health care? We don’t lower costs in health care to get more low income “consumers/patients”, the industry wants people able to pay more, not those who need to be able to get care.

    Getting more consumerism to raise quality will be trumped by those who can only afford to pay less just to get any care – not the best care.

    Stop trying to make health care just a product – it is not.

    Whatever you call me treat me as a human being. Health care professionals can, insurance companies will never do this.

  9. By the way, how did this start about doctors ordering tests or procedures to “maximize” income? I’m not talking about doing unnecessary testing to satisfy the patient, make the doc feel better or CYA, those need to be addressed. What I’m talking about is doctors that frankly are ordering/doing things just to make more money.
    Think about it:
    The majority of doctors are primary care: family practice, internists, pediatricians. None of those docs makes money on tests or procedures, except for a few minor in-office, which believe me, do not bring in that much money.
    Then you have OGB/Gyn, they do Pap smears ( a recommended screening tool) and many have US machines to monitor pregnancies.
    Given the high liability of that specialty, I think you’d be hard pressed to discourage that kind of testing for any reason.
    ER docs order lots of tests, many to CYA, and remember they are treating patients (consumers to you) that they don’t know. But, they don’t make money on those, the hospital does.
    Radiologists do all kinds of tests and procedures, but they can’t order them. And, if they hedge too much to “get more imaging” they will lose their reputation.
    Gastroenterologists do colonoscopies and endoscopies. That’s what they are supposed to do to screen for cancers or make diagnonses.
    Orthopedists do lots of joint replacements, could we argue maybe too many? Possibly. But they also do much less surgery for minor knee meniscal tears and shoulder tears than they used to.
    Cardiologists do lots of procedures, and again much of that is to rule out a major killer in our society, heart disease. I suppose some of them could be doing more than necessary, but again, how much is to CYA?
    Dermatologists do procedures that they get paid for, but that’s why you go there, get your mole removed, checked for cancer, get your face-peel, acne injected, etc.

    If you look at this logically, and taking into account all the specialties and why they do tests for their purposes, how can there be THAT much abuse? I’m not saying it doesn’t happen, I just don’t see the extent that is being touted in the press and by policymakers. It’s like a bad Urban Myth that keeps growing and keeps the public mad at doctors.
    If you have some definitive studies, I’m happy to look at them.

  10. Jim I enjoyed your post but disagree. From my perspective, the consumerist model you advocate will play directly into the hands of healthcare’s big business, which knows that serving consumers is a far better business opportunity than is taking care of patients. I fear that hospitals and pharmaceutical companies in particular will embrace such an opportunity to redefine patients as consumers in an attempt to further absolve themselves of those pesky non-reimbursable responsibilities that come along with taking care of patients – service to the poor, stewardship of resources, and the difficult task of reconciling patient autonomy with beneficence, just to name a few. Of course in many ways this already happens but don’t underestimate the potential for it to get much worse.

    The supplement industry, for example, is entirely consumer-driven. Despite ample “outcomes data” indicating supplements confer no health benefits and often result in substantial harm (see last week’s NEJM), consumers are happily buying and supplement companies are raking in the $$$. In a consumerist system, resources are inevitably diverted to those most able and willing to pay, regardless of need or benefit. Is this really what we want more of in mainstream healthcare?

  11. James,

    All due respect. You want us to call patients consumers, which is what businesses call people they want to get money from. Yet, you want us to respect them and be concerned about the quality of their experience and care. And… you want us to be “providers”.
    Tell you what, I am a doctor (physician if you like) who sees patients. I don’t call them that to their face, I call them by their name. I don’t do tests and treatments just to “make money”, the minor ones I do are to help the “patient” but hey, I do have to pay my staff and my bills to keep my office open, so I do have to make a little money. I spend as much time as needed to take care of my patients and answer their questions. Myself and my staff actually spend inordinate amounts of time doing other tasks for patients that help them, but we will never be paid for, because that is what we do. I consider a “patient” as a person with a health problem or concern who is coming to me for advice and treatment. They may be in pain or anxious, and we try to alleviate that for them and put them on the road to recovery.
    If that’s not what being a patient means to you, then that’s fine, call them what you will, but I will continue to call them patients.
    To me, “maximizing things done to maximize income” is what businesses do to consumers. Unfortunately, some physicians do that, but the 99% I deal with are just trying to do the right thing and get by.
    The last I heard, doctors are the least of the problem in this out-of-control health care world, but seems everyone wants to make us out as the bad guys.
    Excuse the rant, I really won’t care in about another 5-7 years when I retire.

  12. Mike, the patient is the “object” in the sense that the medical service changes or affects that person in a direct way. That’s the point of medicine: to work on people. In that sense, obtaining medical care is a different service than having your car serviced, because the mechanic works on something that is separate from you. Michel

  13. I don’t think this is a very good comparison. A plasma TV is an object, a product, where as healthcare would be considered a service. The person isn’t the object in a healthcare “transaction”, it’s the services rendered. Unless I’m completely misunderstanding something, in that case forget everything I just said!

  14. “We treat “patients” like cows”

    Then stop doing so. Changing what we call them does nothing, by itself, to attentuate that sorry reality.

    I’m a BCBS/RI “customer.” A “consumer” of their sorry-assed coverage administration. See my “Healthcare Shards” posts.

    http://regionalextensioncenter.blogspot.com/2015/06/the-us-healthcare-system-in-one-word.html

    I’m sure they just see me as a money-losing nuisance in light of my cancer illness this year. Yesterday I stopped by a local CVS to get a flu shot, just as I’d done a year ago. The clerk took my insurance card, ran it, and then said “well, it looks like your insurance will pay for the vaccine, but not the injection, which essentially means they won’t cover it.” I joked “can I just drink it?”

    I’d paid the $54.99. I had to have it. I’m traveling out of state next weekend for my grandson’s final college football home game, and I’m already baked from all of my radiation tx.

    BCBS doesn’t call me a “patient.” But, they treat me with indifference at best, stunning bureaucratic ineptitude and obstruction at worst.

    My radiation oncology team calls me their “patient.” They treat me like gold. I would recommend them to everyone and anyone.

    BTW: The indifference is everywhere. Here’s what I posted on Walgreens’ Facebook page (I’ve found that using social media is better than vendors’ lethargic “customer service” web pages) after another pharmacy stop yesterday:
    __

    “I just got jerked around at your store in Antioch California (Hillcrest location). I’m going to take my Rx business henceforth to one of your competitors. I am under treatment for prostate cancer. Today my radiation oncologist wrote me a prescription for FloMax. I took it to the pharmacy, the clerk took it and told me it would be ready about 2:15 PM. I came back a little after 3 PM, and was told that the physician had not dated the prescription, so I could not pick it up. Ok, stuff happens. I replied “fine, his phone number is right on the prescription. Call him.” I was told that they would have to fax a request over to the physician’s office and wait to hear back. The last time I checked, this was the 21st-century, not the 20th. This is not acceptable customer service. They told me they “could not call him.” That’s crap. Make that “would not call him.” I am in my seventh week of radiation treatment, and I don’t feel like running around back-and-forth all day trying to get a simple prescription filled.

    This little episode will also go on my KHIT blog, where I chronicle my misadventures in the healthcare system from time to time (“Healthcare Shards”) during the course of my writing about health information technology issues.”
    __

    I got a quick (though still inadequate, non-resolving) response, to which I responded:
    __

    “My contact information is quite public. My principal email is bobbyg@bgladd.com. My home phone hard line is already in your system. My cell phone number is [xxx-xxx-xxxx]. It is now nearly 6 PM on Friday evening, I guess I will not be hearing from Walgreens in time to pick up this prescription tonight. I am not happy about this. I held off going with this prescription as long as I could, but now I feel like I need it. But, owing to the indifference of one of your employees, I will have to do without it for yet sometime to come. This issue could have been proactively resolved by a simple phone call when it became noted that the date was missing. A phone call would have taken less time than putting together and sending a fax and then waiting for and processing a reply.”

    Sent from my iPhone
    __

    It is now Saturday morning. Still awaiting closure. I don’t care what they call me, just CALL me to say they’ve fixed the problem and I can get my scrip.

    Again, I’m more interested in outcomes than nomenclature.

  15. I ascribe to the idea that there should be catastrophic coverage. One’s concept of “catastrophic” my vary, but like stop loss insurance, individual and aggregate coverage.

  16. Nodding re the trivial costs. That makes my point I think. Today, we’re far far away from being consumers. We often don’t make choices, much less intelligent ones, regarding healthcare. We patiently or passively take what we’re given, and often what we’re given isn’t good. Thanks for the comment.

  17. Interesting observation. You make a good point, but if not “consumer,” then what?

  18. Words reflect culture. But changing words doesn’t change culture.

    Consumers of electronics consume lower quality/ fewer electronics when they can’t afford higher quality/ more electronics.

  19. Jim,

    I am as pro free-market in healthcare as possible (you can test me if you don’t believe me), but I also don’t like the consumer label.

    There is a difference between someone buying a plasma TV and someone getting medical care, the difference being that the person receiving medical care is also the object of the “transaction,” not separate from it.

    And that, by the way, is the origin of the term “patient” which comes from “passion,” i.e., the opposite of action/agent (not patience in its everyday meaning).

    Michel

  20. I think I am a reasonably educated health care consumer. That works out OK until I am faced with unexpected catastrophic costs and cant work or pay my premiums or bills. Then what? Most start looking for ways to start distributing or socializing their risk…enter: current healthcare scenario. Most of who you are calling consumers quickly become patient when even trivial costs are involved.

  21. Oh, for heaven’s sakes… You provide a professional service for people who buy it. Get used to the fact that it’s not all about you, the doctor. I’m no longer a healthcare CEO. I wish truly I’d changed more. I’m trying to change now, on a lesser platform. Doctor should not be about maximizing “things” done to maximize income. I’d like to talk further.

  22. Totally, and absolutely disagree. We treat “patients” like cows. We have to reform how we consider healthcare and have consumers who intelligently “buy” healthcare. I really disagree with what you said. Tell me why I’m wrong.

  23. Ted, you’ve championed the reform of healthcare so long and so well. The idea of insurance is, unfortunately, interfering with the idea of a consumer and customer. You’re very thoughtful here. I think we need normal market forces here, and the exploding app driver will, I think, do this. Let’s hope. Thanks for the post.

  24. Perry is just speaking the truth. Replace doctor with “data entry clerk,” insurance company with “middleman,” and CMS with “demanding bully.”

    As former CEO of an insurance company, I am not surprised you do not see patients as patients. You probably secretly want to call them “dollar signs.” If you really wanted them to be “consumers,” then doctors and patients would negotiate without third party interference and that’s not going to happen.

  25. Another great post by Jim. I don’t think though that simply changing the name of what we call the customer will restore normal market forces to this dysfunctional industry. For consumerism to work you need informed consumers spending their own money in a marketplace rich with competitors. Precious few “patients” really understand the value propositions in health care. More than half are covered by government programs and of the remainder, the vast majority get their coverage from their employer who makes most of the choices for them. This uniquely American model should probably change, but there are powerful, vested financial interests in the way. This is why the ACA is such a miasma of compromises. I think we can make progress, but a consumer driven market for healthcare is a pipe dream I’m afraid.

  26. Well, what would you call them? In any other industry on earth, they are consumers or customers. Here we control them and their choices. This hurts my teeth.

  27. I don’t like the word “consumer’ either. But, then, you’ll take a whole bunch of pedantic flack for calling patients “customers” as well.

    A lot more serious issues to be focusing on.

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