If you want your doctor to call you ” Customer”, just let them know. They will try to oblige.

i have good insurance.

it took me 7 years to find a primary care provided who even approximates what you seem to be talking about, and she’s not an MD. I now have some continuity of care, and if i get hit by a truck, i feel like i would refer to her as “my” doctor. A couple of chronic conditions are now under good control and she has made appropriate referal to a specialist to deal with another problem.

Notice i said 7 years under the best possible conditions, and the physician i am happy with is a DO.

i think your discussion of the doctor patient relationship is highly theoretical for most patients.

I think this is very timely, considering all of the discussion of the octuplet birth in California. I have seen a lot of people say that the fertility doctor is somehow obligated to provide IVF to anyone who can afford it, and must transfer as many embryos as the patient desires. People invoke slippery slope arguments if anyone questions the medical ethics of such practice. I always reply that medicine is not the same thing as ordering off of a menu. Responsible, ethical practitioners have to weigh risks and harms and provide informed consent, which is hardly the same thing as immediately agreeing to whatever the patient requests.

Thanks for an organized list of why this is true for medicine in general. Of course, IVF or other fertility treatments are rarely provided without ability to pay, unlike emergency medicine, but many of the other points apply.

***Ultimately, a physician is by nature in a business. You could certainly work for free and charge nothing for your services, but the mere fact that you charge a fee for your services means that this is a business transaction. I will certainly agree that it is a unique relationship, but it is also a business one.

The problem with this argument is that it relies on defining “business” so broadly that it quickly loses its meaning. For example, is the criminal justice system a “business?” Your criteria above would suggest that it is, because, after all, judges, lawyers and police don’t provide this service to the public for free. They work for money. Is a pastor running a church a “businessman” because his parish pays him? Was Mozart a “businessman” because he took payment for his work? Perhaps, according to your argument, and yet these kinds of activities are generally not understood to be commercial “business” in any ordinary sense of the word. Most human work product is compensated; calling all of it “business” quickly robs the word of any discriminatory power.

Of course, my explicit beef wasn’t with the substitution of the word “business” for “health care” (although, yes, I find that concept objectionable as well) but of the word “customer” for “patient.”

****An attorney-client relationship is similarly unique in that there is a lot more that goes along with the “contract” between vendor and consumer.

True, but advocates, like physicians, don’t call their clients “customers,” presumably because, like physicians, they recognize that the relationship transcends other commercial relationships.

****Also, whether you like it or not, you face competition from other physicians for that patient and their dollars. It’s the ugly side of the business.

I would put it differently. I would say that business is the ugly side of medicine.

****In order to compete, any service must compete on price and/or quality. By truly looking out for the patient as that patient’s physician, you are automatically providing the most important part of that >quality service. There are other elements that a patient/customer wants, though.

I don’t necessarily contest any of this. I would hasten to point out, however, that I am aware of no objective evidence that competition improves the quality of medical care. Indeed, I think you can make a case that it has had the opposite effect. In fact, while the United States has the most robust business/competitive-oriented model of any industrialized nation, some study suggests that the overall quality of our health care falls somewhere between that of China and Iran.

Moreover, I think you have overstated the role of patient choice in the American system–or any other health care system. At Burger King, you can have it “Your Way,” but that doesn’t fly in medicine. It’s all very well to maximize patient choices, but the reality of medicine is that sometimes you run out of choices.

Also, I have found that HMOs, hospitals and insurance companies love to talk about patient choice and free markets when it suits them, not so much when it doesn’t. It starts when the patient gets picked up by the ambulance. I like to say that you could tell the paramedics that you live closest to Henry Ford, that your doctor is at Ford, that your records are at Ford, that your recent surgery was at Ford, that you would prefer to be taken to Ford–and that you are in fact the President and COO of Henry Ford Hospital….and they would bring you to Receiving anyway. And then if you decided you like the doctors at Receiving better after all…oops! No go. Your insurance forces us to transfer you back to Ford. Now you’re back at Ford, and you tell the doctor on call you want YOUR doctor. No dice, your doctor’s in the Caymans for a tax seminar/pina-colada symposium. Well, you say, I’m sick of all this trouble. Just cut the damn leg off, I don’t want it anymore. Umm….no. Customers are always right. Patients are not.

****A patient does, in fact, want the ability to choose their physician. They want someone they trust, someone who will do all the things you outline in your post….[if not](snips) there is complaining.

Yep. See above. But that just says that patients, like customers, want to have choices and be treated with respect. Of course, so do clients and defendents and voters and husbands and wives and brothers and sisters and students and…well, everybody. That doesn’t mean that everybody’s a “customer.” If the word means everything, it means nothing. Let’s go back to Burger King and flip it on its head. Because you, like a patient, want to have choices and be treated with promptness and respect and kindness and burgerly compassion doesn’t make you a Burger King “patient.” There is overlap between what patients need and what customers need, yes. But that doesn’t make them the same at all.

****Now to specific points I had about your points. I completely agree with points 1, 2, and 3. Although with point three, if the patient CAN afford to pay, they can also afford to choose the best level of care they can find. Their level of service is definitely different than those who can not pay.

That is an absolutely correct and succinct statement not only of fact, but also of a lamentable human injustice.

****Point four is correct, but only for emergency medicine.

True, but it underscores the difference between medicine (and law, and certain other professions) and mere commerce. If my roof is on the verge of collapse, it is a true emergency for me, one that could devastate me personally. But no vendor I approach is obligated to come to my aid, especially in disregard of my ability to pay. That’s because in that situation I am merely….a customer.

****Point 5 is correct, but does not take into account other similarly protected relationships such as attorney-client.

Again, I recognize these other special relationships, which, like those of physician-patient, transcend commercial relationships.

****Point 6 is correct, however I must note that when an emergency medicine shift is over, that individual physician passes the care of the patient to a completely new physician whom the patient may not want.

Yes, this has always been a sticky wicket for emergency medicine, and for medicine in general. But the transfer of a patient in no way abrogates or discharges the duty to treat. I think it is most helpful to regard it rather like one officer relieving another. The person may have changed, but the mission remains in place and office being discharged is continuous.

****Point 7 is true, but the harsh reality is that if a profit is not made, you won’t be open to care for the patient for long.

You and I both know that most health care “profits” are not forthcoming from the physician-patient relationship itself, but are in fact highly subsidized–which I think is a point in furtherance of my argument.

****Point 8 is true enough, although with the exception of cigarettes, alcohol, and motorcycles, it’s generally unlawful for anyone to sell something harmful to a customer.

Matt, the pig is a filthy animal, and bacon is very, very bad for you. Firearms…well, let’s not get into firearms. And my point went beyond mere harm and into the realm of need. If you want to buy 7000 lbs of peanut butter as a hedge against inflation, you can find somebody who’d be happy to sell it to you. But if you want a Rx for a medicine you don’t need–even a relatively benign one–no ethical physician would write one for you, regardless of the prospect of profit.

****Point 9 is accurate, but I don’t know that it furthers your point. There are other industries which are counter-cyclical to an economy, such as the fact that thrift store sales go up with the economy goes down.

Point taken.

*****Finally, I never argue with someone who says something is sacred.

Never? Given all the foregoing, are you sure?

****That usually means there’s no way to have an unbiased discussion!

Perhaps not. But then, I never claimed to be unbiased!

Thanks for your thoughtful comments. Glad to see the post generated some turbulence. :^)

Ultimately, a physician is by nature in a business. You could certainly work for free and charge nothing for your services, but the mere fact that you charge a fee for your services means that this is a business transaction. I will certainly agree that it is a unique relationship, but it is also a business one. An attorney-client relationship is similarly unique in that there is a lot more that goes along with the “contract” between vendor and consumer. Also, whether you like it or not, you face competition from other physicians for that patient and their dollars. It’s the ugly side of the business. In order to compete, any service must compete on price and/or quality. By truly looking out for the patient as that patient’s physician, you are automatically providing the most important part of that quality service. There are other elements that a patient/customer wants, though.

A patient does, in fact, want the ability to choose their physician. They want someone they trust, someone who will do all the things you outline in your post. They also want someone who is prompt, somewhere where they are comfortable, and someone who they feel is really concerned for their comfort and care. If they are restricted from choice by their insurance company, for example, there is bitter complaining. If they are taken to a different hospital than the one they choose, there is complaining.

Now to specific points I had about your points. I completely agree with points 1, 2, and 3. Although with point three, if the patient CAN afford to pay, they can also afford to choose the best level of care they can find. Their level of service is definitely different than those who can not pay. Point four is correct, but only for emergency medicine. Point 5 is correct, but does not take into account other similarly protected relationships such as attorney-client. Point 6 is correct, however I must note that when an emergency medicine shift is over, that individual physician passes the care of the patient to a completely new physician whom the patient may not want. In a sense, the further service of the first physician terminates at the end of the shift (although you are still responsible for the services already provided). Point 7 is true, but the harsh reality is that if a profit is not made, you won’t be open to care for the patient for long. Point 8 is true enough, although with the exception of cigarettes, alcohol, and motorcycles, it’s generally unlawful for anyone to sell something harmful to a customer. Point 9 is accurate, but I don’t know that it furthers your point. There are other industries which are counter-cyclical to an economy, such as the fact that thrift store sales go up with the economy goes down. Finally, I never argue with someone who says something is sacred. That usually means there’s no way to have an unbiased discussion!

In 1922 my great aunt was born at home and had to be kept in the oven because she was a little early. Her family was of the most prosperous farmers. Their children each received an orange and a piece of chocolate for christmas, instead of the family sharing the orange and the chocolate. These people were rich in their community. What would they be now?

Neighbors used to have love for each other and share in difficult times. Prosperity has bred greed and mistrust for each other. If you disagree with me on this I’ll sue you.
The push for a patient as a customer is no different than any of our other societal changes. Reverse Darwinism at its best will continue to rot us to something Dr. Osler would never recognize.

Yet, there is something in this catient, pustomer thing. This is a service industry and there isn’t anything wrong with service with a smile. ;]

-olspuppy