July 26, 2007

Time magazine has an interesting column by Dr. Scott Haig, where Dr. Haig complains about the movement in medicine to refer to patients as customers, a trend that fills him with unease:

Patients are those for whom good, young doctors forgo happy nights of beer and dancing. Patients are the ones great nurses worry about, sit up with and linger to take care of, when they could be home with their kids. We continue to study the journals and the books for patients, even when we're 60 and can barely see the words on a page anymore. We take them on knowing they won't pay a dime, knowing they're going to complain, knowing their prognosis stinks. We know how vulnerable patients are — that they literally lie open to us — and that our oath is to do for them what is best. And the best is often not that which "satisfies." To stop giving a narcotic, to do the bigger operation, to deliver devastating news — none of that is satisfying. It is not exactly a good business, selling painful best choices to customers. But it can be the best medicine. The great physician will often prescribe what's unsatisfying, looking farther down the road past "customer satisfaction" to patient well-being.

In a land ruled by the dollar bill, it's perfectly fine to advertise to customers and attempt to take them for all they're worth. Everyone knows that marketing — the ads, commercials, T-shirts and arthritis talks in the backs of diners — is designed to get money from customers. The conventional lie is that marketing informs. Maybe it does, peripherally. It's really done to persuade. But is it fine to persuade patients, so you can squeeze more money from them? Is it fine to scare patients into tests and iffy treatments, to persuade people who aren't sick — who are not patients — that they need treatment anyway? It is far from fine to treat patients like customers.

I disagree. Customers have power, are informed, and make choices. In markets where customers rule, providers are driven to offer better and cheaper services. This should be no less true in medicine.

Doctors who treat patients paternalistically are apt to treat them less well than those who see their job as that of guiding an informed patient through the health care system. I understand his point of view, but I think it neglects the reality of modern medicine where patients are becoming, and will continue to become, co-managers of their own care.

There is plenty of room for charity and altruism in consumer health care - just as there is room for philantrhopy in other markets. Far from demeaning patients and doctors, health care markets will empower them.

Posted by Paul Howard at July 26, 2007 05:15 PM

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