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The words we use to explain our roles are powerful. This change in the language of medicine has important and deleterious consequences.

The relationships between doctors, nurses, or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction.

Marketplace and industrial terms may be useful to economists, but this vocabulary should not redefine our profession.

Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts.

These guidelines for care are touted as strictly scientific and objective.

But that is only a small part of a much larger whole, and to people who are sick, it’s the least important part.

The words “consumer” and “provider” are reductionist; they ignore the essential psychological, spiritual, and humanistic dimensions of the relationship — the aspects that traditionally made medicine a “calling,” in which altruism overshadowed personal gain.

Furthermore, the term “provider” is deliberately and strikingly generic, designating no specific role or type or level of expertise.

Each medical professional — doctor, nurse, physical therapist, social worker, and more — has specialized training and skills that are not recognized by the all-purpose term “provider,” which carries no resonance of professionalism.

“Clinical judgment,” for instance, is a phrase that has fallen into disgrace, replaced by “evidence-based practice,” the practice of medicine based on scientific data.

But evidence is not new; throughout our medical education beginning more than three decades ago, we regularly examined the scientific evidence for our clinical practices.

A customer or consumer is guided by “caveat emptor” — “let the buyer beware” — an adversarial injunction and hardly a sentiment that fosters the atmosphere of trust so central to the relationship between doctor or nurse and patient.

Reducing medicine to economics makes a mockery of the bond between the healer and the sick.

In contrast, clinical judgment is cast as subjective, unreliable, and unscientific.


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