4 Words We Should Abolish From Our Healthcare Lexicon
Medical language can be slow to change, even as the field itself sees rapid innovation. In fact, over the last 20 years, the vocabulary we use in health and medicine has changed very little.
While this may seem unimportant at first blush, a deeper look reveals a different view.
The Deceptively Simple Matter of Words
Words are containers for ideas. Ideas, in turn, comprise innumerable emotional and intellectual ingredients coming together in the brain, which the brain then seeks to name. Once the brain manages that, we exchange ideas through language.
The trouble is that every person’s brain works a little differently. Our thought processes, backgrounds, and emotions all vary. So the ideas behind our words don’t always match up.
Take the word tree, for example. When I say tree, depending on where you grew up, you may imagine a tall pine, a full oak, or a scrubby mesquite — your life experiences and preconceptions color which idea the word evokes. If I want you to imagine a specific type of tree, I need to use a particular term.
Language use has a broader sphere of influence than we may realize. In the healthcare context, I believe our word choices even influence the prevailing thoughts around the practice of medicine. And if we want to change the conversation, we must change the language.
As concierge and DPC physicians, we’ve already departed from the unsatisfactory manner conventional healthcare operates. We don’t have to bring its deficient vocabulary with us.
Four Terms to Reconsider (And Possible Alternatives)
We do a disservice to ourselves when we use language without pausing to consider the messaging or status quo it reinforces. Much in medicine requires nuance, and I suggest we use language to communicate those nuances accurately.
Below are four pervasive medical terms I suggest we eradicate and replace with these more reasonable alternatives.
1. Provider —> Physician
I’d love to see the word “provider” immediately stricken from the healthcare lexicon.
A “provider” is anyone who provides a service. This generic blanket term conveys nothing besides that fact. An Uber driver provides me with a ride from point A to point B. A restaurant provides me with a meal. And, yes, a physician provides medical care.
But no one orders a car from a ride provider or orders from a meal provider. It’s weirdly generic and, frankly, demeaning.
My medical degree didn’t confer upon me the title of medical provider. I became a medical doctor. This distinction is important because a doctor has a specific job.
A doctor holds a position of respectful influence in people’s lives. On a personal, one-on-one basis, we’re trying to help people daily. This is significant work that should be recognized and appropriately named.
The words doctor and physician communicate the reality of the role we play. But the word provider devalues our profession. When we, as physicians, use the term, it’s a form of self-harm.
What about other medical practitioners covered under the “provider” umbrella? If they work in a clinical setting, then I suggest clinician. The physical therapist, for example, is clinically oriented and provides a clinical service. Or, we can simply call them by their job title.
When someone says “provider,” what they actually mean is clinician, physician, or doctor. Let’s say what we mean.
2. Consumer —> Patient
Healthcare aims to get the best health outcome as early and quickly as possible, with the least amount of friction. We want people to get better faster.
The people we’re serving in healthcare are patients, not consumers. Like the term provider replacing physician, the term consumer degrades the perception of the healthcare experience. And consumers differ radically from patients.
I’ve never seen a consumer in the intensive care unit. That’s a patient. What’s the difference? Mainly, choice.
Consumers have many options and the freedom to choose or reject those options. As a consumer, I might visit a café and decide not to buy a drink. I might buy a sandwich instead or nothing at all. I can leave, and it’s no harm, no foul.
Patients have a very different experience, fettered by various limitations. While a consumer has free will, a patient has tethered will.
A patient isn’t in the ICU for a bit of window shopping, considering whether or not to make a purchase. Patients have a problem they must solve and make a decision, usually from minimal options.
There are other differences, too:
- Consumers have the money they earn and can decide how much of their resources they want to spend on a given item.
- Patients pay through insurance, and the system’s convoluted way means they don’t typically know their care costs.
- Consumers typically receive an immediate benefit from their purchase — a drink, an iPhone, or a trip next month.
- Patients don’t know if or when their medical care will be effective.
- Consumers are excited to go shopping.
- Patients are anxious and afraid.
- Consumers are adding something new to their lives that they didn’t have before.
- Patients are getting rid of something or recovering something they lost.
Clearly, a consumer has little in common with a patient, and the terms are not interchangeable. Healthcare isn’t a festival of products and services for free-wheeling consumers to choose from.
Bonus Word: Patient-Centric
On a related note, by thinking of patients as customers, we’ve allowed a strange adjective to creep in: patient-centric.
Perhaps the intent is to indicate high care and attention toward patients, but that should be present anyway.
Patient-centric sounds like a business-savvy term, but what does it mean? What are patients the center of? No complex system revolves entirely around the end user, and healthcare is no different. Instead, it’s a composite of the clinical, patient, and data/technology universes, with communication at the center.
Let’s leave patient-centric, a derivation of customer-centric, out of our lexicon.
3. Reimbursement —> Payment
When you go to the supermarket for milk, you’re a consumer buying an item. You pay the money; you get the milk. You’re not reimbursing the grocery store for the milk. You’re paying them.
The same is true for any product or service you buy. And yet, in medicine, we’ve allowed reimbursement to become the standard terminology concerning insurance companies.
Reimburse and pay are synonyms of a sort, but their connotations diverge. Where pay is straightforward, reimbursement implies repaying someone who spent money on your behalf. You reimburse your buddy for picking up your movie ticket; you don’t reimburse Walmart for your shampoo.
Using the word reimbursement for insurance payments to doctors makes the relationship sound like a deal between friends. If one friend forgets to send over the money (or decides not to), oh well. It was just a friendly agreement anyway, and it looks like the doctor made a bad deal.
The lay public doesn’t understand what it means for a doctor not to receive reimbursement. It’s confusing, and that’s not an accident. But if we change the language from reimbursement to payment, people will understand that it’s unfair when doctors don’t get paid for their work.
4. Explanation of Benefits (EOB) —> Terms of Limitation
Lastly, this insurance-oriented term really gets my goat because it’s so incredibly wrong.
If you’ve ever used medical insurance to see a doctor, you know about the little sheet of paper your insurance company sends after the fact titled “Explanation of Benefits” (EOB). The problem? It mainly highlights the benefits you’re not getting.
Rather than explaining anything, an EOB lists several inscrutable codes and descriptors alongside a chart of what the company paid, what they didn’t, and what you now owe. No detail, no explanation.
Furthermore, as Americans know all too well, the notation of what the insurance company paid is surprisingly low, surprisingly often. And the patient foots the rest of the bill.
There’s no explanation, and there are few benefits. A better name for the EOB might be “Smoke and Mirrors Statement” or “We Decided Not to Pay for That.”
Of course, those will never pass muster, but something like “Terms of Limitation” would undoubtedly be more realistic.
Final Thoughts
As concierge and DPC doctors, we intentionally design our medical niche to create an optimal healthcare environment for physicians and patients alike.
We can support this change with the way we talk about our world. Let’s let our terminology accurately reflect and convey our value to patients.
Dr. Jordan Shlain is the founder and managing partner of Private Medical, a referral-only private practice office in San Francisco, Silicon Valley and Los Angeles established in 2002. Private Medical was recently highlighted on the front page of the New York Times Business section as the best-in-class medical practice for individuals and families that value health as their most valuable asset. Their twenty-one physicians integrate internal medicine, pediatrics, naturopathic & gynecologic medicine to ensure a highly personal medical experience that emphasizes proactive prevention, surveillance and rapid response teams during crises both big and small. Dr. Shlain is an active advisor to many Silicon Valley companies that help solve real problems for real doctors.
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