The Provider Will See You Now

by Danielle Ofri
New York Times

I can’t quite remember when the term “provider” slipped into the hospital lexicon. It was perhaps 10 years ago, when our hospital started hiring physician assistants and nurse practitioners to share the clinical load. In contrast to the regular staff nurses, who cared for the patients in conjunction with the doctors, physician assistants and nurse practitioners would see patients independently, the way the rest of the doctors did. So there needed to be a term that would include all three groups – physician assistants, nurse practitioners and doctors — who could have primary responsibility for patients.

“Health care provider” came into vogue as the catchall phrase and was quickly truncated to just “provider.” The term does have its upside, helping to minimize hierarchy. History has shown us that medical hierarchy usually serves more to stomp on underlings than to provide leadership. In fact, physician assistants, nurse practitioners and doctors have more similarities than differences in their day-to-day interactions with patients, even as they come from unique backgrounds and bring different strengths to the table.

Still, the term “provider” has never stopped irritating me. Every time I hear it — and it comes only from administrators, never patients — I cringe. To me it always elicits a vision of the hospital staff as working at Burger King, all of us wearing those paper hats as someone barks: “Two burgers, three Cokes, two statins and a colonoscopy on the side.”

The other term that makes my skin crawl is “hospitalist.” Whenever I do full-time inpatient work (in contrast to outpatient clinic work), I’m called a hospitalist. What the heck is a hospitalist — someone whose specialty is taking care of hospitals? In my mind I see a car repair shop, with the entire hospital building hoisted on the lift, and all the — ahem — providers underneath with wrenches, drills and oilcans in our upraised arms.

I always thought my annoyance with these terms was just my personal pet peeve, something that allowed my mind to wander off to fast food and auto mechanics during dry administrative meetings. So I was grateful to come across an article by Dr. Pamela Hartzband and Dr. Jerome Groopman in The New England Journal of Medicine.

The authors put their finger on what is so grating about these terms. They note that the term “provider” has a deliberate sterility to it that wrings out any sense of humanity, and connotes a widgetlike framework for that which is being “provided.” It makes us feel like a vending machine pushing out hermetically sealed bags of “health care” after the “consumer’s” dollar bill is slurped eerily in.

But the most profound unease created by generic terms like “provider,” the authors point out, is the sense that medicine is turning into a corporate entity. Buzzwords like “provider,” “consumer,” “quality,” “productivity,” “synergy” — all are just that, buzzwords. They come from the corporate world and carry a plastic blandness with them, even if the concepts they embody do have some validity for medicine.

Oh, it’s easy to achieve perfect efficiency between consumer and provider, with maximum productivity. Type your symptoms into a computer, pause for 0.15 second while it scans its superior database, then get your diagnosis and a printout of your prescription. This would indeed be the most efficient health care delivery system. But it would be hard to call this medical care.

Perhaps “care” is the key word. Medicine — as opposed to fast food joints, auto body shops or investment firms — involves care. This is intrinsically human and cannot be commoditized the way burgers, carburetors or mortgage-backed securities can be.

Medicine certainly has inefficiencies and poor practices that can and must be fixed. The corporate perspective has offered some helpful insights into where we can improve. The corporate analogy, however, can go only so far. Medicine cannot be automated in the same way a factory can.

Sure, some parts of medical care can truly benefit from the widget approach — pre-operative check-lists, drug interaction databases, electronic medical records. But the essence of medicine — how we make use of science to care for patients — cannot be codified to fit neatly into a shareholder’s report. The “consumers” who fall ill are human beings, and the “providers” to whom they turn for care are human beings also. The “transactions” between them are so much more than packets of “health care.”

So yes, maybe it’s splitting hairs to want to be called a doctor, rather than a provider. Yes, maybe there is a hint of paternalism in preferring “patient” over “consumer” or “customer.” And yes, there are probably grander problems in medicine that require urgent attention.

But words do influence us. In a world that is increasingly depersonalized, it is ever more critical to maintain protected spheres of human interaction. When my children fall ill, I will be so relieved when a nurse or doctor or physician assistant — a human being — enters the room. It is a signal that my children — the patients — will be cared for. I can always take them to Burger King later for provisions.