Heart of the Matter



I am not sure when it occurred. I don’t know how it happened. I don’t think anyone took a vote on it. It happened gradually over the last decade. I think it happened when the administrative staff became larger than the medical staff. In order to include everyone under the same umbrella, everyone became a provider.

The title of doctor, nurse, technician all disappeared, and we all became providers. All those patients in our waiting room suddenly became consumers or clients. My grandfather ran a grocery store and had a lot of customers, and my father was a lawyer and had a lot of clients. None of those customers or clients would come to see me as their doctor with their illnesses today if I were a provider. The use of the terminology of “providers” and “customers” lowers all health care staff to the lowest common denominator and demeans the concerns of my patients.

Dr. Sidney Goldstein, professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit.

Dr. Sidney Goldstein

When I sit in my examining room across the desk from my patient I face a human being who has come to see me as a doctor because they’re in search of the treatment of a real illness or concern. I am not a car salesman providing advice about buying a new car. All those nurses that surround me and help me care for patients are part of that process. The blood and x-ray technicians are taking part in the solution of that patient’s problem. They are not mechanics in the garage or salespeople in the showroom.

I do not mean to diminish the role of the auto mechanic and salesperson, but they know and I know that our roles and are different and we are not just providers of a medical commodity. They do not expect me to deal with them as though they were coming to buy a car. They understand that we are actually trying to cure and treat worried patients and not to sell to customers in a show room.

This change in nomenclature that has permeated health care has had significant effects on how medical care is provided. Hospital care has been depersonalized in order to expedite hospital stays and maximize reimbursement. Gone is the hospital visit of your doctors when you need them the most.

Part of it is the complexity of contemporary care that requires the input from varying levels of expertise. Patients are often shuttled from one doctor to another. Communication is carried out through the web and rarely doctor to doctor. Often doctors are dealt with both at the patient level and the administrative level as commodities off the shelf, like buying a pair of shoes. And doctors in the hospital and in the clinic can be replaced by another one as the shift changes or the schedule dictates with little regard to the patient’s – or customer’s – choice.


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