As I read through the many online journals and newsletters about healthcare, I am struck by the ubiquity of articles showcasing healthcare consumerism. I am increasingly interested in “consumerism” as an expression of patient-centeredness, and I often wonder if “patient centeredness” has become an empty cliché for many of the people that I meet. It is an antiquated phrase that lacks a widely accepted working definition among healthcare professionals. At best, patient-centeredness is another example of a concept of “knowing” elucidated by a famous quote from Justice Potter Stewart on “pornography” when he wrote in a legal opinion on hardcore porn that he could not define it but he knew it when he saw it. I guess with patient-centeredness the reality is that we not only have trouble defining it but that like the Marbled Murrelet (a rare endangered bird species in the redwood) forests, patient-centeredness is often hard to see in the field.
I do know that I have observed that physicians cringe as if they have heard fingernails scratching a blackboard when they are asked to think about their patients as consumers, and I see them turn away with distaste from conversations about the changes in practice and strategy that they must consider and probably adopt if they are to prepare for the emergence of consumerism as a force that may determine their future success. It is as if accommodating to consumerism is an example of what they perceive as the generalized attack on their professional values. To these physicians consumerism seems “smarmy.” Those who talk about it as an important strategic concern often see them turn away from the conversation or use the moment to recount a litany of injustices and stresses that they currently are forced to bear, followed by a demand that patients assume more personal responsibility for their health.
I well remember my own sense of repulsion and aversion in the late ‘60s and early ‘70s as we began to see television ads about pharmaceuticals, health insurance, hospitals and, finally, medical practices. Advertising seemed to diminish the lofty objectives of our calling and turn us into a field that more mundane, like used-car sales and body shops. But then other staid institutions like colleges, universities and even churches began to advertise and we got used to seeing healthcare advertising everywhere.
Ironically, in retrospect, advertising may have been the first step toward healthcare consumerism. Initially it provided nothing but names and promises and the goal was name recognition, not a real discussion of services provided, customer convenience, price, or information from trusted sources on comparable quality. That sort of information was treated like the secret formula of Coke. Now I see billboards that look similar to lottery ads where the potential winnings for this week’s jackpot continually change. Now billboards bear numbers in flashy lights that tell me how long or short the wait will be at a local suburban emergency room or how many days it will take me to get an appointment with a PCP. What does this advertising tell us about what we think healthcare consumers want? What does it say about patient centeredness in general?
