Consumer or patient?
Patients. Families. Members. Consumers. Customers. Employers. Clients. Communities. Citizens. Students. Government. As a combined health care, dental, financing (insurance), research and educational organization, we use many words to describe those we serve. We also use various terms such as experience, healing relationships, service excellence, satisfaction, reputation, brand and top-of-mind awareness to describe the perceptions of those we serve. How do we make sense of this word salad?
Words evoke emotions and frame thinking. In the past, I bristled when I heard “consumer” or “customer” used in place of “patient.” The terms “consumer” and “customer” felt corporate and seemed to demean the near sacred nature of healing relationships conveyed to me by the term “patient.”
Over time I lost my emotional response to “consumer” when I realized in my own health care experiences I often viewed myself as a patient, consumer or both depending on circumstances.
Imagine examples outside of health care in which you consider yourself a consumer. You stroll into Caribou for a cup of coffee, order a book from Amazon or buy milk from a grocery store. You pay for the transaction with some combination of time and money, and expect hassle-free service or an item that performs as advertised. The hallmark of your consumer role is a sense of your own power as you feel in charge of your time and money. And as a consumer, you think about service excellence, rather than trusted empathic relationships and a healing experience.
In contrast, the hallmark of being a “patient” is your feeling of fear and vulnerability. You want trusting and empathic relationships to provide guidance and comfort in a strange and foreign land. Being a patient involves interactions between human beings, rather than consumer transactions. You likely think about healing and empathic experiences, rather than service excellence.
The day I lost my vision I felt afraid and vulnerable. During my recent transient ischemic attack (TIA), I sensed I was in a strange and foreign land “on other side of the bed.” In both instances, I could not possibly feel in charge, and I desperately needed the empathic trusting relationships that come with being a patient. I did not want to feel like a consumer and did not think about “service excellence.”
Over time, these events have shifted into periodic visits to physicians to check my blood pressure, eye pressures and receive medication refills. During these encounters, I feel in charge and want hassle-free service. I appreciate the relationships, but I don’t have the same need for them as I did during the first few days of the acute episodes. In both instances, healing involves my transformation from a vulnerable and frightened patient to feeling like an empowered and in-charge consumer. Additionally, I feel like a consumer in health care when I receive a flu shot or when my children needed a strep screen. In these examples, my time trumps an empathic relationship, and I think about service excellence rather than a healing experience.
Similarly, I encountered a variety of needs and roles in my involvement with the legal profession. When I was sued for malpractice, I felt very vulnerable in the strange and foreign land known as the courtroom. I didn’t feel much like a consumer and preferred to be called “client” by my attorneys. However, years later when I was working on my will, I actively shopped around for an attorney, felt in charge of the process, and returned to the comfortable “consumer” role.
The in-charge role of “consumer” and the vulnerable role of “patient” are not on opposite ends of a spectrum; we can experience both roles simultaneously and the balance may shift in the blink of an eye.
The graphic below depicts a useful way to think about the roles of patient and consumer.
The y-axis represents the empowered and in-charge consumer seeking hassle-free service and value, while the x-axis marks the fearful and vulnerable patient needing empathic, healing relationships. An individual can be in any of the four quadrants one moment and shift to another quadrant in the blink of the eye.
When I lost the vision in my left eye, I started in the lower-right quadrant (vulnerable and fearful patient), and over several weeks as I adjusted to the change in my life, I shifted to the upper-right quadrant (I wanted regular follow-up visits that fit my busy schedule, yet lingering fears remained). Now, more than 12 years later, I am solidly in the upper-left quadrant as I fully accept my loss and want follow-up eye checks to be as convenient as possible.
Consider some illustrative vignettes which demonstrate movement within the quadrants. A young woman named Rita is visiting her dentist for a routine check-up and cleaning. She senses no vulnerability, feels in charge and wants to get in and out of the office as quickly as possible. She decides to ride her bike to the appointment. She feels like a consumer. Unfortunately, on the way home, she falls off her bike and shatters four teeth. She is worried about the damage to her mouth and wonders when she can return to work and how she will tolerate the pain. In the blink of an eye she has changed from in-charge consumer to a vulnerable patient needing an empathic caring relationship.
Kathy is 35, married and has two young children. She is in charge of the health care decisions for her family. She feels like a consumer when she chooses her family’s health plan and takes the kids to their well visits. The evening after she selects the health plan through her employer, her youngest daughter is hospitalized with respiratory failure from influenza. She and her husband find themselves in a strange and foreign called the Intensive Care Unit. They need guidance and empathic relationships to navigate the world of ventilators, heart failure and kidney failure. In a blink of the eye Kathy shifts from an in-charge consumer to a scared and vulnerable family member.
Many individuals with chronic disease are in the upper-right quadrant, similar to where I was a few months after my vision loss. They live every day with their chronic disease, and as a result, feel empowered and in charge, yet also may harbor lingering fears about complications.
Our work requires understanding the needs of those we serve at any given moment and understanding that those needs may change in the blink of an eye. The work of healing relationships includes supporting individuals to move from fear and vulnerability to feeling empowered and in charge.Paradoxically, healing relationships support the process of patients becoming consumers.
Please use comments below to describe your thinking about the role of patient and the role of consumer.