The Semantics of Health Care

By Gali Katznelson

shopping trolley with medicine
The push toward commodification of health care is a luxury not everyone has. (toons17/Thinkstock)

Recently there has been a shift in popular parlance toward referring to PCPs as primary health care providers. Not primary health care physicians or practitioners, but providers.

This change seems to have increased in popularity after the original passage of the ACA, specifically with the opening of the health insurance marketplaces.

But it was particularly jarring, as a Canadian, to become accustomed to terminology that reframes physicians as providers, and patients as consumers.

Ostensibly, this language comes from a movement to empower patients to be more engaged in their health care rather than to accept passively that the “doctor knows best.” It is an effort to shift away from health care delivery by paternalistic doctors of the past, and toward the contemporary active patients who take ownership of their health and participate in making decisions. As a result, doctors are framed as service providers who cater to the needs of their consumers.

But we must challenge this narrative.

We must question whether it is ethical to continue to frame health as one more thing that can be bought and sold in the marketplace.

We can agree that health care is different from a fancy car or a flat screen TV. So when we use the same language to discuss health care as we do when we debate upgrading our internet speed from a service provider, we degrade what health care is and what it could be.

When we think of health care as a commodity we make it okay for companies like Goldman Sachs to release a report where they pose the question “Is curing patients a sustainable business model?

The answer, of course, is no.

But that does not mean that the imperative of the market should outweigh the moral imperative to cure people who are sick.

Beyond debasing the value of health care to a mere commodity, consumerist language excludes people who cannot afford to be health care consumers. Can the 40 million Americans who lack health insurance be consumers?

The only people that health care consumerist language empowers are those who already have power. These are the people with privilege and the financial and social resources to weigh medical options and to make fully informed decisions. It’s the people who have the luxury to be able to afford health care.

Language matters because it has the power to continue to uphold this status quo.

There have been plenty positive shifts to address language in health care. For example, person-centered language is one form of advocacy that seeks to put the person first and the disability second in order to emphasize that a disability does not define a person.

There have also been efforts to undermine health care through language. The seven words (vulnerable, diversity, entitlement, transgender, fetus, evidence-based, and science-based) that made headlines after it was reported that the CDC advised employees to avoid using them in budget documents serve as an Orwellian reminder of how institutions can manipulate language to suit their agendas.

Language reflects our values and beliefs, and influences our attitudes and behaviors. So while it’s true that the terms “patient” and “physician” may perpetuate a paternalistic relationship that Western medicine renounces, if we want to make a positive shift in health care language, let’s consider inclusive terms that emphasize the value of the clinical relationship instead of words that commoditize it.

We can think of patients and physicians as partners or participants. People who are actively involved in shared decision making. People who make decisions that are more valuable than the mere marketplace transactions they would make for goods like entertainment and travel. Most importantly, since most people cannot afford the title of “health care consumer,” let’s imagine ways that our language can create a world in which everyone can participate in health care.

Acknowledging health care as a basic human right is a good place to start. And if one day universal health care becomes reality in the US, let’s not hide behind consumerist terms like “single-payer” when talking about it.

Gali Katznelson

Gali Katznelson

During her fellowship year, Gali Katznelson was an MBE candidate at the Center for Bioethics at Harvard Medical School. Before her master's degree, she completed a bachelor’s degree in Arts & Science at McMaster University in Canada. Her fellowship project focused on clinicians' perceptions of the uses and regulations of smartphone mental health apps.

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