Patients, Not “Customers”

Patients, Not “Customers”

By James G. Hutton, PhD

Since the 1960’s, about the time President Kennedy unveiled his “Consumer Bill of Rights,” the idea of being a “customer” has been sacred in America. But it’s time to abandon our faith in the power of consumerism. The United States has become such a culture of consumption that consumerism is now entrenched even in the most sacred of our institutions, including education, religion, government and healthcare. The conse-quences are not pretty.

In medicine, commercialization and customerization of the American healthcare industry have not brought the benefits that were promised. If anything, concepts such as managed care, HMOs and the privatization of hospitals have created more problems than they have solved, adding new layers of costs and bureaucracy, and often taking medical decisions out of the hands of people qualified to make those decisions.

Declining Trust, Especially in Healthcare

During the last 40 years the percentage of Americans who say they have a great deal of confidence in their institutions has been cut almost in half. From 1966 to 2004, the percentage of Americans who said they have a great deal of confidence in American medicine dropped a whopping 41 percentage points, from 73 percent to 32 percent, according to annual polls conducted by Louis Harris & Associates. Among the major social institutions that were measured — universities, the military, the media and so forth — only the legal profession and Congress saw a steeper decline in credibility than the medical field.

The Source of the Problem — and the Consequences

Much of the problem is that many Americans falsely believe that treating people as consumers or customers ensures greater accountability. The reality is usually the opposite; when institutions like hospitals, schools and churches treat their patients, students and members as “customers,” those institutions almost inevitably begin to pander to their audiences, becoming more responsive but to the wrong things. They lose sight of their basic mission and ultimately become less accountable.

For example, the steep decline in doctors’ credibility is partly the result of focusing more on keeping patient-customers happy than on doing the right thing. Case in point: a study by the Food and Drug Administration found that 69 percent of physicians prescribed the specific drug that patients asked for. Worse, more than a million antibiotic prescriptions are written by doctors each year to treat viral infections.

Another part of the problem is the prevailing political and economic philosophy in the United States that looks to the market to solve all of our national problems, from crumbling prisons to failing schools to spiraling healthcare costs. Unlike true markets for consumer or industrial products, healthcare markets do not allow free access to all potential buyers and sellers, they are almost completely circumscribed by a variety of laws and regulatory agencies, and they do not provide for free and open access to information such as prices and physician performance.

Treating healthcare as a market can be damaging not just to patients, but to healthcare professionals as well. Increasingly, healthcare products and services are being denigrated and turned into commodities, undermining the value of those products and the authority of healthcare providers. Audiologists, for example, are being threatened by calls for hearing aids to be sold over the counter, while pharmacists are being threatened by Internet sales and direct-mail distribution of prescription drugs.

The overall result of the customerization of medicine is that our healthcare system is simply not what it should be, in either reality or perception.

The Challenge for Nurses

The customerization and commodification of healthcare has had a limited impact on the nursing profession thus far. In fact, it appears that nurses have fared relatively well in terms of credibility, because a significant percentage of Americans believe that nurses have been truer to their profession than some other healthcare professionals, and have not been as prone to compromise their standards for financial gain.

But just as doctors’, audiologists’ and pharmacists’ credibility, professional authority and earning power are being challenged by the customerization and commodification of healthcare, so too can nurses’. One threat is that, in a global economy, nurses can be trained and imported from other countries in large numbers, as has been the case with engineers and computer programmers. Another threat is that nurses will be perceived merely as customer-service providers, rather than professionals.

The way for nurses to avoid such problems is very simple: Treat patients like patients, not like customers. That really means two things:

1. Treat patients better than you would treat customers. Nurses should treat patients as something different and something more than | just a source of revenue for the hospital, clinic or doctor.
2. Help give patients what they need, not necessarily what they want. Giving people what they need is far more difficult and requires far more courage, wisdom and leadership than giving people what they want, but it is essential in maintaining the integrity of any institution or profession.

James G. Hutton, PhD, is a marketing professor, consultant, speaker, and the author of The Feel-Good Society: How the “Customer” Metaphor Is Undermining American Education, Religion, Media and Healthcare (available at Amazon.com). He can be reached at hutton@fdu.edu. 

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