The human face of medicine
December 2022—Many of us were raised on alluring stories of the good old days in medicine, when physicians enjoyed long-term, respectful relationships with their patients. I grew up hearing from my father, an obstetrician/gynecologist, and my mother, a nurse, about their frustrating transition from this to a modern reality in which these relationships were strained by a seemingly impenetrable health care bureaucracy.
Like so many pathologists, I have felt intimidated by such behemoths as the CMS, the FDA, and insurance companies, as well as smaller monoliths like the C-suites or dean’s office at health systems and medical schools where I have practiced. But what I have realized by working with the CAP is that dealing with these entities can be more manageable when we create positive and productive relationships with the people who work in them.
That simple act of seeing the people within an institution is important in our own day-to-day experiences in medicine. I can’t tell you how much I hate being referred to as a “provider.” The word is like nails on a chalkboard to me because it underscores the ongoing commoditization of medicine. I know many of you take issue with this term as well. It contributes to this concept that seeking health care is about seeing a doctor strictly to get a medication or a test. We aren’t test dispensers. We are highly trained, highly educated individuals who pride ourselves on diving into each patient’s case and finding life-changing answers that would not be possible without our expertise. We are people who help people. Calling us “providers”—a term that is also used to refer to hospitals and clinics—is dehumanizing.
There’s a scope of practice issue here as well. In many cases, the term “providers” is used to refer to physicians, advanced practice nurses, and physician assistants. Each of these types of health care professionals has something valuable to contribute to patient care, but we are not interchangeable. Our education, training, and responsibilities are completely different. Lumping us all together as “providers” strips away the important distinctions among our roles.
Of course, we also need to think about how our patients understand the term. One genetic testing company surveyed consumers as part of an effort to determine which language would be most effective for reporting results. The term “provider” was confusing to a lay audience; many people thought it referred to their insurance company. It is so important to be clear in our communications with patients so they understand who we are and what we can do for them. Referring to us by a term they don’t associate with physicians only erodes what is meant to be a healing environment and diminishes the physician-patient relationship.
I worry about this as we look to the next generation of physicians. We are interested in recruiting the best and brightest into the field to replace us. But terms like provider can be demoralizing or have a cheapening effect on the perception of what we do in medicine. We can’t risk letting the best of future generations be put off by the evolution of health care into nameless, faceless organizations—the exact kind of bureaucracies that so thoroughly frustrated my father in his day.
We must find opportunities to remind our colleagues that we are physicians and to demand to be taken seriously so we can advocate for our patients. How we communicate with each other matters, and that goes beyond eschewing terms like provider. I often hear people say things like “the lab said” or “pathology said.” There’s no one named “lab” or “pathology” in the organization. Especially in our behind-the-scenes roles, it’s easy for our patient-facing colleagues to overlook the actual human beings running the tests and generating the results they need every day. It’s important to find ways to humanize the folks behind these roles. It’s not about our egos, but about creating more effective relationships within these complex health systems to break through the bureaucracy and deliver better results for our patients.
Dr. Volk welcomes communication from CAP members. Write to her at president@cap.org.