RESPECT

It's been quite awhile since I've posted here. However, there is more than a disturbance in the Force. Many within the House of Medicine are in disarray, dispirited, and ready to throw in the towel. Younger physicians are pursuing MBA's and the like as a hedge in case they have to fold up their tents and depart. Men and women enter Medicine with more debt than some houses cost. Stress and burnout are now a thing, no longer the result of ennui but from the abuse of a system which has turned professionals into data entry clerks. This cannot go on. I wrote this piece for the Medical Society of the State of New York's monthly News of New York. Given the dispirited nature of many of our colleagues, this needs a wider audience. Please accept this humble effort as a step on the road to recovery.

R-E-S-P-E-C-T

The term “provider” has bothered me for a long time. And it should bother you as well. This week, ACP President Dr. Robert McLean posted Defining our identity does not include the ‘P word’ for his September President’s message. The central theme is a reminder that the practice of Medicine is a profession. Physicians have a unique relationship with patients that is considerably more than the “Cable Guy” who comes to install your tv service. Dr. McClean writes:

… Such a fundamentally unique and sacrosanct relationship as that between patient and physician is not merely “providing” a health service. And that is why the term “health care provider” is so inappropriate. The patient-physician relationship does not consist of simple transactions where we provide and patients consume. That marketplace terminology implies that health care can be conceptualized as just another commodity.

… The primacy of this relationship has been eroded with the commoditization of aspects of the health care delivery system.

Dr. McClean is not the only physician upset by “provider creep.” Washington pediatrician, Dr. Niran Al-Agba goes one step further, writing in the Kitsap Sun: The sneaky cynicism of calling your doctor a 'provider'. She traces the history of provider as a pejorative back to 1930’s Germany:

… According to Dr. Saenger, who wrote Jewish Pediatricians in Nazi Germany: Victims of Persecution, “the 1937 issue of the Reichs Medizinal Kalender, a directory of doctors, the remaining Jewish doctors in Germany were stigmatized by a colon placed before their names. Their medical licenses were revoked in 1938. They could no longer call themselves 'Arzt' or 'doctor.' They were degraded to the term 'Behandler' or freely translated, 'provider.'

She continues:

Insulting any person on the basis of their race, ethnicity or gender is morally wrong. Using the word “provider” to describe a physician is and will always be insulting, personally and professionally; it is demeaning and devalues the education and degree conferred upon every physician. Why are physicians forced to suffer repeated use of this derogatory professional insult? And why have physicians as one professional body not risen up in anger at this injustice?

While I would not equate those who call physicians “the P word” with the Third Reich, folks should realize that Provider is insulting and demeans our noble profession.

Dr. McClean concludes:

And by the way, this terminology issue was raised through the ACP Board of Governors way back in 2008. Hence, it has been ACP policy since 2009 to eliminate use of the term “provider” and “prescriber” in lieu of “physician” in all publications and communications. Pass it on.

I leave you now with the inimitable Aretha Franklin.