November 25, 2013
From Physician to Provider: Can Doctors Put The Genie Back Into The Bottle?
By Michael D. Shaw
In October, 2011—two years before the disastrous rollout of healthcare.gov—an article appeared in the New England Journal of Medicine entitled “The New Language of Medicine.” Written by Pamela Hartzband, MD and Jerome Groopman, MD (both from Harvard Medical School and Beth Israel Deaconess Medical Center), this article should be required reading since it attacks the very core of today’s wrongheaded notion of industrialized and standardized patient care.
Time-honored terms used for more than three centuries have changed. As the authors put it: Patients are no longer patients, but rather “customers” or “consumers.” Doctors and nurses have been transmuted into “providers.”
No doubt, these verbal cosmetics are part of an overall effort to reduce costs. Hartzband and Groopman continue: “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.”
As with so many other changes in how health care is organized and administered, the new terminology derives from Medicare, and was adopted by the private insurance industry in the 1970s. Sadly, this—and much more—was pretty much accepted without question by doctors, who after all are exceptionally good at learning what is new, and doing what they’re told. According to the authors:
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.
Of course, given the current preference in all reimbursement schemes for procedural over cognitive medicine, surgeons are placed at a higher level…for now. But even the currency of surgery has been devalued. Very few old school surgeons, who interact with patients and have an encyclopedic knowledge of the underlying medicine, exist anymore. Be assured, this is no accident. Far better for the current scheme to have surgeons become little more than skilled mechanics. Lower reimbursements are surely on the horizon.
Enough of the bad news, even if it is scarcely news to most doctors. What can be done to stem the tide? How can doctors upgrade their practices in this era of Obamacare?
One approach is called concierge medicine, whereby patients pay an annual fee (usually in the range of $500 to $3,000) to their primary care physician. The promise is enhanced care, quicker appointments, and more face time with the doc. As pediatric heart surgeon Bradley Allen MD puts it:
The doctor works with a base of 300-600 patients instead of the 3,000-5,000 typical in the ACA era. Doctors and patients who can afford it love concierge medicine: It allows treatment to be administered as the doctor sees fit, instead of as if the patient is on an assembly line with care directed on orders from Washington. Concierge-type care was easily expanded to specialists. The top surgeons now simply opt out of Medicare or become out of network providers, allowing them to bill patients directly. Many have joined the plastic surgeons and ophthalmologists who work on a straight fee-for-service basis.
For many physicians, the first step is to upgrade their appearance. The folks at Classico note that the white lab coat is the most iconic representation of the medical profession. Health care professionals deserve to look their best, and let’s face it, the standard issue white coat leaves something to be desired. Classico has truly reinvented the white lab coat, and in 2009 was awarded First Prize in the Industrial and Life Science Design Category of the International Design Awards.
Xiruo Guo, President of Classico US Inc., recently told me:
Classico is a bespoke, tailored article of clothing, to match the image of a successful modern professional. In fact, such an individual—like a gifted surgeon, a wise internist or beloved specialist—commands respect, by virtue of his or her skills and education, as well as the suit or dress that physician wears. So, if clothes make the man (or woman), Classico completes the ensemble with look of dignity and style.
Dignity and style should be just what the doctor ordered.