In contrast, clinical judgment is cast as subjective, unreliable, and unscientific.But there is a fundamental fallacy in this conception.The words we use to explain our roles are powerful. This change in the language of medicine has important and deleterious consequences.
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Marketplace and industrial terms may be useful to economists, but this vocabulary should not redefine our profession.
“Customer,” “consumer,” and “provider” are words that do not belong in teaching rounds and the clinic.
During our first year of medical school, we spent countless hours learning new words, memorizing vocabulary as if we were studying a foreign language.
We discovered that some words that sounded foreign actually represented the familiar: rubeola was measles, pruritus meant itching.
Whereas data per se may be objective, their application to clinical care by the experts who formulate guidelines is not.
This truth, that evidence-based practice codified in clinical guidelines has an inescapable subjective core, is highlighted by the fact that working with the same scientific data, different groups of experts write different guidelines for conditions as common as hypertension and elevated cholesterol levels The specified cutoffs for treatment or no treatment, testing or no testing, the weighing of risk versus benefit — all necessarily reflect the values and preferences of the experts who write the recommendations.
But that is only a small part of a much larger whole, and to people who are sick, it’s the least important part.
The words “consumer” and “provider” are reductionist; they ignore the essential psychological, spiritual, and humanistic dimensions of the relationship — the aspects that traditionally made medicine a “calling,” in which altruism overshadowed personal gain.
The consumer or customer is the buyer, and the provider is the vendor or seller.