Names and Labels in Healthcare

Blog post by Colin Hung

Over the past several weeks on #hcldr we have tackled a number of important and “deep” subjects:

• Interoperability
• Population Health
• ACSO Framework on the value of cancer care
• Privacy
• Sugar and it’s impact on health and health care

Since this the final holiday long weekend of the summer here in Canada and the US, I thought we’d go with a topic that’s a bit “lighter”. This week I’d like to discuss a few names and labels we use in healthcare. Specifically:

• Patients vs Consumers
• Physicians vs Healthcare Providers
• “Difficult” patients, physicians, nurses and administrators

Patients vs Consumers

In recent years there has been a trend towards referring to treating patients more like healthcare consumers. The “consumer” term comes from the choice that (some) patients have in where they can go to receive care. The rise of rating websites, personal trackers and health gamification (where you get points for healthy behavior) have helped to solidify this analogy.

But are patients really consumers?

In 2013, Leana Wen MD wrote a Huffington Post article that disagreed with this comparison:

 I believe that health care is a human right. A patient deserves health care as a right. But does a consumer? …health care is not a commodity like cars and TVs. 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.

On the other hand people like Paul Barr wrote this in a Hospitals & Health Networks post:

…patients are likely to start acting more like consumers in the coming years and hospital executives need to be ready…think about the trends that are giving patients more say in how they get and pay for care — price and quality transparency, high-deductible insurance and mHealth, for starters. And, the consumer-patient will demand high-quality service.

Personally I do not like the consumer analogy for one simple reason: people can chose to be a consumer or not, but for many there is no choice whether to be a patient or not. Nobody chooses to have a disease or become ill. Patients in that situation have a totally different mindset and outlook than a consumer in my opinion.

Physicians (or nurses) vs Healthcare Providers

I must admit that at internal meetings, I use the term “Healthcare Providers” when referring to clinicians, nurses and physicians. However, when I meet actual providers in real life, I don’t use this term. I switch back to using “Doctor”, “Nurse”, “Physician”, etc.

At various conferences I have met physicians and nurses who truly object to the term “providers”. Some do not like how impersonal the term is. The act of caring for another requires specialized knowledge + skill, it is not a commodity item which is what many believe a provider offers. Some do not agree with lumping together so many disparate practitioners of care. They believe each is unique and should be acknowledged.

Some people, like Mary Dijkstra, Medical Staff Services Manager at Munroe Regional Medical Center use “Provider” only when referring to a group of physicians and other clinicians as noted in this blog:

I only use the term ‘Provider’ when it is a mixed group of physicians and other clinicians or a just other clinician. I also use ‘Doctor’ or ‘Physician’ consistently. I believe in my position as head of Medical Staff Services it is not appropriate to call members of the Medical Staff by their first names.

I think A Country Doctor said it best on this KevinMD blog post:

Ultimately, whether others call us physicians or medical providers, it is still up to us to define our professionalism and to defend our personal standards.

The “Difficult” label

There is one label in healthcare that I believe is universally loathed – “Difficult” – as in difficult patient, difficult doctor/surgeon, difficult nurse and even difficult administrator. This label has special significance in healthcare because it can affect the way care is delivered to patients.

Nurses and other clinicians will not speak up when a “difficult surgeon” is performing a procedure, which can lead to vital information not being shared. People labeled as “difficult patients” have a tendency to experience worse symptoms (according to a VA Study in 2011). There is even a famous Seinfeld episode that focused on Elaine’s troubles after being labeled a difficult patient.

Some would argue that it isn’t that people are difficult it’s that situations are difficult. Physicians, nurses, patients and administrators are all human and are all under a lot of stress, especially in a hospital or clinic. It’s therefore not surprising that there are times when someone lashes out and acts in an abnormal way. To be labeled “difficult” in this type of situation is a little unfair.

Join the #hcldr weekly tweetchat on Tuesday September 8^th at 8:30pm Eastern (for your local time click here) where we will discuss names and labels in healthcare:

• T1 Patients vs Consumers? Which are we? Which should we be?
• T2 Physicians vs Healthcare Providers? Is one term better? Are they the same?
• T3 As healthcare leaders how can we help to end improper labeling of people (colleagues and patients)?
• T4 What name, term or label in healthcare would you like to see ended?

 Resources

“Rebranding Patients as Health Care Consumers: Trend with Extreme Caution”, Leana Wen MD, Huffington Post, July 12 2013, http://www.huffingtonpost.com/leana-wen-md/patient-vs-health-care-consumer_b_3580363.html, accessed September 5 2015

“The Trouble with Treating Patients as Consumers”, Augusta Meill and Gianna Ericson, Harvard Business Review, January 9 2012, https://hbr.org/2012/01/the-trouble-with-treating-pati/, accessed September 5 2015

“Consumers vs patients: Healthcare’s biggest misunderstanding”, Akanksha Jayanthi, Becker’s Hospital Review, February 18 2015, http://www.beckershospitalreview.com/healthcare-information-technology/consumers-vs-patients-healthcare-s-biggest-misunderstanding.html, accessed September 5 2015

“Patients are Not Consumers”, Paul Krugman, New York Times, April 21 2011, http://www.nytimes.com/2011/04/22/opinion/22krugman.html, accessed September 5 2015

“Treating Patients as Consumers Is a Growing Strategy”, Paul Barr, Hospitals & Health Networks, January 21 2015, http://www.hhnmag.com/Daily/2015/January/patients-as-consumers-strategy-blog-barr, accessed September 5 2015

“Whom Does Health Care Serve: Patients, Consumers or People?”, Kenneth Kaufman, Hospitals & Health Networks, April 28 2015, http://www.hhnmag.com/Daily/2015/April/patients-consumers-people-health-care-serve-article-kaufman, accessed September 5 2015

“The implications of provider versus doctor”, A Country Doctor MD, KevinMD.com, April 13 2012, http://www.kevinmd.com/blog/2012/04/implications-provider-doctor.html, accessed September 5 2015

“Doctor vs Provider – What Do YOU Call a Physician?”, TeamMedGlobal, February 7 2014, http://teammedglobal.com/medical-staff-services/doctor-vs-provider-call-physician/, accessed September 5 2015

“How to Deal with the ‘Problem Physician’”, Mary Ann Porucznik, American Academy of Orthopaedic Surgeons, January 2013, http://www.aaos.org/news/aaosnow/jan13/managing3.asp, accessed September 5 2015

“8 Tips on How to Deal with a Difficult Physician”, Leigh Page, Becker’s Hospital Review, March 28 2011, http://www.beckershospitalreview.com/asc-turnarounds/8-tips-on-how-to-deal-with-a-difficult-physician.html, accessed September 5 2015

“When the Nurse is a Bully”, Theresa Brown RN, New York Times, February 11 2010, http://well.blogs.nytimes.com/2010/02/11/when-the-nurse-is-a-bully/, accessed September 5 2015

“Good Patients and Difficult Patients – Rethinking Our Definitions”, Louise Aronson MD, New England Journal of Medicine, August 29 2013, http://www.nejm.org/doi/full/10.1056/NEJMp1303057, accessed September 5 2015

“On Being a Difficult Patient”, Michelle L Mayer, Health Affairs, September 2008, http://content.healthaffairs.org/content/27/5/1416.full, accessed September 5 2015

“Who is the Difficult Patient – The Art of Being a Medical Consumer”, Tamara McClintock Greenberg Psy D, Psychology Today, September 8 2013, https://www.psychologytoday.com/blog/21st-century-aging/201309/who-is-the-difficult-patient, accessed September 5 2015

“Difficult patients more likely to experience worse symptoms”, Science Daily, January 27 2011, http://www.sciencedaily.com/releases/2011/01/110126081603.htm, accessed September 5 2015

Image Credit

Hello My Name is…221/365 – Robert Occhialini https://flic.kr/p/6Nkkq9

 

Tags: consumers, difficult, healthcare, nurses, patients, physicians