COMMENTARY

No, Patients Are NOT Consumers, and MDs Are NOT Providers

Arthur L. Caplan, PhD

Disclosures

April 23, 2019

This transcript has been edited for clarity.

Hi. I'm Arthur Caplan. I'm at the NYU School of Medicine where I run the Division of Medical Ethics. A recent article by scholars at the Hastings Center, a bioethics think tank in Garrison, New York, made an interesting point: The authors said they didn't think that patients should be viewed as consumers.[1]

I really agree with that argument. I also would argue that doctors should not be viewed or referred to as providers. In our healthcare system, more and more, the language of business is shaping and changing descriptions of what doctor-patient encounters are all about.

The Hastings scholars said that talking about patients as consumers implies choice and activity that patients and would-be patients don't engage in. For example, if I'm a consumer, I might be buying beer, or trying to figure out where to go on vacation or what hotel to stay in. I can search websites and find information on products. I can certainly price-shop a little bit, if I choose to, and find the best deal.

A patient or would-be patient often has no choice. They are in a system and told to go to this hospital, clinic, or practice; they don't have any choice about what to do. If you're beset by a sudden health problem, you don't have time to go shopping to see what orthopedist or diabetologist you want to see. You might quickly receive recommendations from friends or your primary care doctor, but you're not going to act like a consumer.

Consumer behavior is not characteristic of our healthcare system because, in all honesty, it is not really a market-driven business. Our healthcare system doesn't have the information, and the patients are not in a position to do the shopping or research that would lead them to act like it was a market.

I think they're much more vulnerable, more dependent; they're more frequently in the dark and they often have no choice. The emergency room you wind up in is not something you shopped for online.

I really think we should stop talking about our patients as consumers. Doctors should be referred to as physicians, not as providers or other business descriptions. I know everybody is very excited these days about bringing in practices from industries, such as the hotel industry, where we try to get patient satisfaction by having better meals or nicer sheets.

I'm worried about that trend because I don't think hospitals should become hotels. They should become places where infections are low, treatment is efficient, and people are comfortable, given what we have to do there. I'm bothered about that kind of marketing push.

Overall, I don't want to replace medical ethics and medical professionalism with business jargon and business ethics. I don't think that serves patients well. I think it starts to have implications for how to operate the system, which are not good for physicians because it starts to make them feel more like pawns or agents, without professional standing and without the respect and authority that go with the profession.

I know that medicine has to involve money; I'm not naive about that. But it doesn't mean that we have to invoke a business framework when we're trying to make decisions about how best to serve patients.

I'm Art Caplan at NYU Medical School. Thank you for watching.

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