Thus Spake Zuska

I don’t particularly enjoy having needles poked into my scalp and neck and shoulders and temples and I especially don’t like having them poked into my forehead just above my eyebrows. Yet I allow my neurologist to turn me into a pincushion every three months because regular botox treatments subdue my migraines, and nothing else does. I like my neurologist; I trust him, and we have a good doctor-patient relationship. On this last visit we discussed my current medications and how they’re working, and agreed that I could probably start scaling back one of them. My neurologist is at a teaching hospital; at this office visit, a doctor from China was with him. With my permission, he observed my botox procedure, and I talked to him about my medical history, especially the migrainous stroke. All in all it was a fairly typical visit.

Traveling home on the regional rail train, I encountered a poster advertisement that proclaimed:

It’s NOT ENOUGH for us to be THE BEST HOSPITAL we can be. We want to help you become…

and here I expected to read something like “the healthiest person you can be.” But what actually followed was

THE BEST CONSUMER you can be.

Say what?

What does being a consumer have to do with my health care, and why does a hospital want to help me be the BEST one I can be? Well, of course, I’m being silly. Here in the good ol’ U. S. of A., health care is ~~treated like~~ a commodity, just like ~~anything~~ everything else. I could almost hear them singing “Be – all that you can be – a consumer – of health commodities!”

I did not experience my visit with my neurologist and the care he provided as akin to a trip to the mall, but in Chester County Hospital’s eyes I suppose I was CONSUMING a botox treatment.

The problems with this commodification of health care are many, but let me just state the painfully obvious. When I went to the mall today and bought myself a spiffy new pair of ankle boots, that was consumption. I made a choice to buy a product that I didn’t really need but wanted and could use. When I went to my neurologist last Friday, it wasn’t like I woke up thinking “gee, a botox treatment would be just the thing. I believe I’ll sashay on down to Jefferson Headache Clinic and buy one!” The interaction I had with my neurologist last Friday had nothing in common with the transactions I conducted at the mall today.

Now, the folks who are getting botox designed as beauty treatments because they fear aging – those folks are consumers. Maybe CCH can help them be the best ones they can be. But you don’t choose to be ill, and being treated for illness isn’t an optional frill.

The transformation of relationships like teacher/student and doctor/patient into that of service-provider/consumer is not good for society. We should see education and health care as things that society needs to provide for its citizens. In this case, the individual is part of society, and this provision is good for individual and society alike. But a consumer is an individual all on his or her own, free to consume just exactly as much health care or education as they can afford.

If you can’t afford an iPod, you can’t have one. Oh well, you’ll live. If you can’t afford college, you can’t go. Oh well, you can always work at McDonald’s. If you can’t afford to treat your diabetes, too bad. Oh well, look on the bright side: you won’t have as long to worry about not having enough money because you’ll die younger! Too bad you didn’t plan to be born with more money. How else were you planning to be THE BEST CONSUMER you can be????

Comments

#1 ScientistMother
December 22, 2008

I’ve never understood why there is such a fight against universal healthcare in the USA. It is such a shame that a country with such vast resources and a belief in opportunity, can not embrace the idea that healthcare is so important to the success of its nation.
#2 Phil
December 23, 2008

Here’s the essential problem. With most businesses, the more you use their product the more money the company makes. The health/insurance industry is the opposite. The more you use the product the less money the company makes.
The other big problem of course it that the consumer who wants the service the most will be turned away as a consumer of the product.
This is not a free market, a perfect market or a functioning market of any sort. High barriers to entry stop new producers from entering the market.
#3 PalMD
December 23, 2008

when patients become “clients” or worse, “customers”, the doctors may treat them like clients rather than someone who has entrusted their life to them.
#4 Brian
December 23, 2008

A fundamental problem is that we in the U.S. have a tendency to pretend that things are subject to free market forces, even if, you know, they’re not.
#5 Ann
December 23, 2008

You socialist!
#6 thoughtcounts Z
December 23, 2008

ScientistMother: I think the reason many people oppose universal healthcare isn’t that they don’t think it would be good for people to have healthcare, but rather that they don’t believe it is the government’s job to provide it. They think the way to have a “successful” country isn’t to have the government ensuring that every person is individually successful, but instead doing the bare minimum of its obligations and staying out of people’s lives the rest of the time. The other reason is that they don’t believe that wealthy people should pay high taxes to pay for taking care of the poor. (In order to believe this you have to also believe, at least subconsciously, that wealth is determined by level of trying, so that wealthy people all worked for it and poor people are just lazy.)

I don’t personally agree with this perspective, but I understand the arguments, and thought I could shed a little light on it.
#7 Isis the Scientist
December 23, 2008

You’re absolutely right to compare the frivolity of daily purchases with this idea of health care consumerism. Consumerism implies that we make conscious choices about our consumption and that, need be, the things we consume are optional. Good, quality health care should be a fundamental human right and medical decisions should be based on risk-benefit type discussions with the physician — not what is nececssarily in vogue.

But, I have to admit that for as stellar as this post was (I expect nothing less from my feminist hero, Zuska), I was a little distracted by the mention of a pair of ankle boots. Are you going to offer more details or was that just a painful tease for the domestic and laboratory goddess?
#8 Zak44
December 23, 2008

Telling someone you want them to be the best “patient” they can be is, in effect, asking them to be sick. My guess is that most of the people the poster is aimed at are not in immediate need of hospitalization. (Hope not; that’d be one sick train ride.)
#9 Zuska
December 23, 2008

Isis, I blush to offer more details, for I am sure they are not worthy of a domestic and laboratory goddess. They are quite stylish, however, for an unemployed disabled hairy-legged feminazi with arthritic toe joints. I shall post a photo just for you, dear.
#10 Comrade PhysioProf
December 23, 2008

The transformation of relationships like teacher/student and doctor/patient into that of service-provider/consumer is not good for society.

Ain’t that the motherfucking truth. Transforming everyfuckingthing in American society into a corporate-controlled greedfuck free-for-all is why our nation is swirling down the motherfucking shitter. The so-called “conservative” movement got everyfuckingthing it wanted, and–what a fucking surprise–they destroyed the fucking country. The dirty fucking hippies tried to tell the country what would happen if it bought the sick-fuck right-wing snake-oil, but no one listened. And look at us now.
#11 Zuska
December 23, 2008

Ah, CPP, you say it like no one else can. Or will.

I can’t tell you how angry that ad on the train made me feel. I mean, I expect to hear that shit about health care as a commodity from the Rethuglicans, but not from the health care providers themselves. Sigh.
#12 chat
December 24, 2008

A fundamental problem is that we in the U.S. have a tendency to pretend that things are subject to free market forces, even if, you know, they’re not.
#13 QB
December 24, 2008

Last time I encountered “consumer” for “patient” was in a magazine about Schizophrenia. I believe it is an attempt to not infantilize the “patient”. The implication for patient is that they are subordinate to the doctor, and the illness defines them. I think that using consumer, instead of patient, intends to put the doctor on the same level as the person being treated, as well as not define the person by their disease.
#14 Zuska
December 27, 2008

QB, I see what you are saying, but I don’t agree with the logic. Calling someone a patient is describing exactly what they are. That’s not what infantilizes them, because a doctor can work in partnership with his or her patient to manage the patient’s care. Good doctors listen carefully to their patients and take seriously what they have to say. They don’t treat them like stupid little children. But calling someone who goes to see their doctor a “consumer” changes that relationship in significant ways in my opinion. Names are important. When I worked in the pharmaceutical industry I often argued with some of my colleagues about whether or not participants in clinical trials ought to be referred to in our documents and conversations as “patients”. My feeling was, no: we are not providing them with health care, they are offering their bodies for medical investigation. They are subjects in a study, not patients in a doctor’s office, and they ought to be called just that – subjects. Patients are patients, not consumers.
#15 b-ran
January 22, 2009

Technically if you purchase something you are labeled as a “consumer”, so therefore someone who purchases pharmaceuticals is a consumer. When you go to the doctor, you are a consumer of a service.

Even though this may be true, I agree that a patient should not be called a consumer because this makes it sound like a doctor is just concerned with selling a “service”, which most of them are not. You wouldn’t think of a patient who attends therapy as a consumer because if all the therapist were doing was selling a service, they probably wouldn’t be as personable.

If a hospital or drug company refers to people as consumers, it makes it sound like they don’t really care about helping people, they just want to make money.