When I left bedside medicine to pursue a career in the publishing world for addiction medicine and primary care, I started hearing the term “clients” or “customers.”
Clients and customers in rehab facilities. Clients in treatment. Clients in therapy. Customers in my practice. Nowadays, this is not just happening in addiction medicine, but in all medical specialties.
Why call a patient a customer?
I asked why individuals are referred to as clients or customers in addiction treatment, and I was told that the term “patient” assumes a sick role, whereas “client” or “customer” doesn’t necessarily mean sick, and carries less shame. In my professional opinion, this is false.
Whether you are struggling with diabetes, heart disease, or addiction, you still struggle with a disorder. Regardless of whether the disorder is physical or mental, the patient should not be shamed. Using the term “client” to negate the fact that the individual is sick, in hopes of making them feel less shame, isn’t the best avenue to take.
Physicians treat patients, not clients or customers. When I write or edit for a medical column, I refer to individuals being treated in a medical setting as patients, not customers or clients.
The difference between patient and customer
Unfortunately, medicine has become a business, and in a business, the person paying for goods or services is a customer or client. It’s true that the economic cost of providing healthcare will always have to be considered in seeking solutions to the healthcare crisis.
Still, medicine is not like other businesses, and patients are not like other clients or customers.
Writing in The Patient Experience Journal, Kathy Torpie, psychologist, author, and healthcare speaker, explains the distinction.
“‘Customers’ are generally well people who enjoy elevated status by virtue of their potential to purchase goods or services. Patients, on the other hand, are (by current definition) not well. Their status is greatly reduced by illness or injury that renders them vulnerable, frightened, often in pain, medicated, exhausted and confused. In spite of these limiting factors, patients sometimes have to make important, often complex, decisions in a short time frame.”
Patients and physicians require a therapeutic alliance
The patient-physician relationship is a therapeutic alliance that requires trust, empathy, open communication, respect, and compassion. Customer service is often scripted, and the bottom line is that the customer pays the business at the time of service.
A therapeutic alliance is important for the patient’s wellness, safety, and satisfaction. The patient is often grateful to the physician for providing them with a treatment plan that is discussed between them. Treating the patient like a customer—like someone who merely partakes of healthcare “services” or “products”—renders the interaction impersonal, and corrodes these therapeutic principles.
Customers shop around; patients seek immediate relief
Customers shop for bargains and sales and often compare products, prices, and features, making a deliberate choice as to whether or not to purchase the product or service.
In an emergency room, patients show up not because they want to be there but because they are injured, ill, or in pain and seek relief from a doctor. They are not looking to compare products and costs but to alleviate any illness or pain they are experiencing.
Patient safety vs customer satisfaction
In medicine, patient satisfaction is not the priority—but patient safety and effective treatment are.
For example, if a patient presents to a physician demanding antibiotics for a common viral cold, and the physician views the patient as a “customer,” they may prescribe antibiotics to satisfy the individual and send them on their way.
However, when a physician views the person as a patient, they feel empowered to educate them and explain why antibiotics may be harmful (leading to antibiotic resistance), and offer other remedies to help the patient feel better.
There are other ways that patients differ from customers.
Patients are usually unhappy to see the doctor, but customers are often happy to purchase an item.
Patients are usually forced to seek medical care because they are in pain or are sick, whereas customers willingly buy a product.
Patients are not directly paying for healthcare—usually, their insurance companies are paying for it. In most cases, patients have no idea how much the service costs at the “time of purchase,” nor do they “pay” at the time of service. They are often billed later. Customers pay for goods and services out of their own pocket, know how much the product costs at purchase, and must pay at the time of sale.
Patients are not buying goods or services for which they can demand a guarantee, as with a commercial product. Medical care may not be successful or deliver a positive outcome. Patients may receive medical care that is not life-saving, or upon seeking care, they may receive a medical diagnosis that ends in death.
A disservice to ourselves and our patients
When doctors become customer care reps, we see our patients as customers, and our reimbursements and incomes become tied to patient satisfaction scores.
As a result, we may change how we treat our patients.
We may no longer initiate difficult conversations with our patients, or give them honest feedback about their health or substance abuse, because we fear they will score us poorly. Patients may then come to appointments with certain expectations, and demand that physicians meet these expectations, which potentially leads to overprescribing and overtreating, in the physician’s attempt to avoid an angry reaction from the patient.
We, as physicians, know this is not good patient care. This may be deemed good customer care by customer service industry standards, but we are in the business of patient safety and wellness. In the end, yes, medicine is technically a business, and we are often caught between doing what's best for the patient and protecting ourselves.
Assumptions that don’t apply
When we label our patients as consumers, we are adopting a set of assumptions.
We assume that our patients have the time, energy, knowledge, and focus to consider all treatment options objectively. We also assume that our patients have the time to shop around for the best treatment and doctors, and have equal access to other options, in addition to insurance coverage for all of these different options.
We also assume that the patient can shop around and talk to physicians without purchasing care at the time, even if they are actually billed for the consultation. These assumptions may be true for very specific circumstances, such as preventive care and a few elective services.
These assumptions are generally untrue in the context of a medical illness. As anyone knows who has ever had a serious illness, or been a caregiver for a cancer patient, an elderly parent, or an injured child, most of the time, none of these conditions apply.