Doctor vs Provider - Are they the same?
I’m hurting today, I’m hurting more than usual which is probably a better “advocate” way of stating that. Technically I started hurting more on Sunday. If you are curious, while at a campaign manager training my neck started popping violently which led to an increase in pain. This pain, combined with an incoming thunderstorm, is causing my rheumatoid arthritis to flare. Since I hurt more than usual this means I’m not in the mood to job hunt so I’ve decided to do some writing in hopes it will provide some pain relief through distraction. Distraction can be a useful treatment opportunity, learning can be more powerful than opioids in pain management (hear that health insurance, maybe you should help pay for my laptop since it helps me deal with my chronic pain).
Today’s topic or chronic pain distraction treatment. Is it disrespectful to call a doctor a “healthcare provider”? Since I need a distraction, I’m going to add another question. Is calling a doctor a “healthcare provider” a part of some massive conspiracy by healthcare payers to get patients like me to accept care from physician assistants or nurse practitioners because their reimbursement is cheaper? I’m not proposing this question out of jest or an attempt to be funny, I saw an actual M.D. on Twitter (it will always be Twitter to me) state this very question but as fact, not a question for debate. Sometimes you got to love the internets.
Quick history. I’ve been a publicly recognized patient advocate or leader now for roughly 13ish years. This question, should we call doctors healthcare providers, seems to appear on social media in cycles every 2 to 3 years. Often, it starts with a prominent scientific paper or some major healthcare news story referring to doctors as providers. Some M.D. takes offense and then goes on social media, often on Twitter, to fire up the troops so to speak. As a chronic patient I’m obviously biased, but as far as I understand the M.D.’s argument is that it is disrespectful or demeaning to call doctors “providers” due to their extensive education and training. By calling a doctor, doctor, it shows that patients and caregivers are acknowledging their expertise. If any doctors are reading this post, please feel free to correct me, I don’t want to assume or misrepresent this argument in anyway.
Titles are interesting. On the one hand, most titles are earned through hard work, a willingness to expand one’s intelligence, and a desire to become an expert on a topic or procedure. On the other hand, there is an element of ego (both good and bad) at play. It is probably a rush to be called Doctor X, Governor Y, President Z, or General Brewington.
General Brewington, talk about a cheesy paragraph transition (if you are not aware of my joke here Brewington is my last name). Dad is the retired general in the family, a Brigadier General (that’s a 1 star general if you are not an expert on military rank). Now I’ve earned some cool titles, but no one is going to call me Stanford University Epatient Scholar Alan Brewington, it’s just too many words for one. So, for the purpose of brevity, I’m going to use Dad’s title as an example for my thoughts and ideas on this question of whether doctors should be called providers.
Two quick stories regarding Dad and his generalship title. First, while on inspection with a 2-star general, Dad and General Kane entered the room where pilots stored their equipment and flight suits. In the room there was a team of enlisted soldiers who were hard at work doing what they were supposed to be doing. According to the senior enlisted person who told me this story, he did not realize Dad and General Kane had entered the room which meant he failed to call his team to attention, a big no no in military land. This pissed General Kane off something bad and immediately started to yell at Dad for this mistake since the enlisted team was under Dad’s command. According to the senior enlisted person who told me about this incident, later that day Dad tracked him down and said that he was proud of the team because they all were doing exactly what they were supposed to be doing. In addition, Dad would gladly accept the heat for this mistake because ensuring the room was ready for the pilots was vastly more important to the mission of the fighter wing than acknowledging the presence of 2 generals. Dad used his rank (title) to protect, not to glorify.
Second story. Unfortunately, I did not learn about his until after Dad had died. On base there was some school (I’m not sure what the school was for) that was undergoing graduation. Dad was very impressed with the hard work and quality of graduates and wanted to acknowledge it. In order to keep the attention on the grads, Dad apparently tried to sneak into the ceremony through the backdoor. Someone saw Dad there and stopped the ceremony in order to acknowledge his attendance. From what I understand, Dad ordered this person to stop in mid-sentence because the attention and glory belonged on the graduates and not him. The students had earned the acknowledgement of a General, the General was not there to steal their glory from hard work and accomplishment. Titles are cool and should be respected but only if they are used for the greater good and not just for the glorification of an individual.
Going to medical school is not easy and is a killer accomplishment, not unlike being promoted to the rank of General. In addition, the desire to help and serve, whether as a doctor or military personal should also be respected. Wanting to serve others is noble and righteous, worthy of respect on its own.
Let’s talk about the word respect for a minute. On a high level, no one, absolutely no one can take away something one has earned through hard work and sweat. Due to this, we (the royal we) tend to look at respect as something received from others. We want respect from patients or lower ranked officers for example. However, we tend to forget about giving respect to the thing earned. In this case, it would be the person giving respect to the institution of doctoring, or Dad giving respect to the institution of being a General. If respect is given to these noble institutions by the individuals seeking them then it doesn’t matter what others think or do. You are now a part of the institution; one needs to respect that more than what others think.
Now, let’s talk about the economics of respect for a moment. According to a quick google search, a person without health insurance can expect to pay between $300-$600 per doctors visit. Another way of stating that is for a 15-minute doctor’s visit, the market has determined the value to between $300-$600. For an hour or 4 visits, that’s $1,200. To take it further, that is $48,000 a week. Now Dad had like 1,200 people under his command and between 11-13 jets (which cost about $30 million apiece if I remember right). I know for a fact; Dad wasn’t making $48,000 a week. Which is harder, commanding 1,200 people with a budget of 10’s of millions or diagnosing cancer or reducing my chronic pain. The simple answer is doctors have a distinct advantage when it comes to the economics of respect (for the record, I’m not saying doctors should be paid less. If anything, I’m saying Dad should have been paid significantly more for his skill set).
A patient’s perspective. I am not a consumer of healthcare, I’m a chronic patient who spends most of his life at pain levels that would send many to the emergency room. Due to current state of medicine, often I must call bad pain days Wednesday because the ER can’t provide me with relief. I’m don’t consume healthcare, I need healthcare…there is a difference. With that in mind, do you under any circumstance think I care who or what gives me any kind of pain relief. Do you think I care who provides me with better control of my rheumatoid arthritis? Now imagine how little I care considering in order to possibly receive any kind of relief I need to spend a significant amount of money. My pain and lack of quality of life is being affected by a market force and not simple human compassion and desire to help, yeah titles don’t mean much too me.
Let’s now talk some about my second proposed question, is the term provider being used by payers in a conspiratorial attempt to make doctors obsolete because they are expensive to reimburse? Conspiracy theories are stupid. For example, the orange one loves to talk about how he won the last presidential election. Just for a moment, stop everything and take a moment to think about the number of people needed in order to pull off such a conspiracy. We are talking thousands and thousands of people needed with the understanding they can never ever talk about stealing the election for the entire conspiracy won’t work. The logistics alone on a conspiracy like that are mindboggling which is another reason I think they are stupid.
The doctor I mentioned earlier clearly stated that the term “providers” was being used by payers as a conspiracy to essentially do away with doctors. For this to be true, every employee at Medicaid, Medicare, Blue Cross, Blue Shield, United Healthcare, and every other health insurance company would have to be on board. A secret this big would get out. A simpler, and much more logical explanation exists. In order to improve access and health equity, policy makers have decided to utilize people like nurse practitioners, physician assistants, etc now since the need is immediate and it takes doctors 7 to 10 years to complete college, medical school, and residency. Let’s use our heads people, not everything is a conspiracy.
O.k. I think I’ve ramble on for long enough. It’s time for a grand conclusion.
Unless you are hurting bad and are looking for a distraction to write about, like I did with this post, this should not be an issue. Should chronic patients, like me, respect doctors? YES, of course we should. Could chronic patients, like me, do a better job showing our respect? YES, of course we could. That said, if your doctor stops a conversation, treatment, explanation of your diagnosis, or delays a test to lecture you on how you should call them a doctor and not a provider, run away quickly. If possible, fire your doctor’s ass immediately. If they stop doctoring to lecture you on using the term doctor over provider, they are not respecting the institution of doctoring.
Truly great doctors, and yes fellow patients most doctors are truly great, use their powers to protect and serve patients from the healthcare system. They search for backdoors into clinical trials when we can’t afford meds, they share educated opinions, so we don’t have to undergo expensive tests, they stand with us when the system tries to burry us in nonsense, most importantly, they become our friend when we most need it. Because they are chronic humans too, truly great doctors make mistakes and failures can and do happen.
Fellow patients, mistakes and failures do not mean that a doctor doesn’t deserve their title or our respect. A mistake and failure mean something didn’t work at that moment, that’s the drawback of being unique humans. There are no absolutes when it comes to medicine, only similarities. There is also no such thing as risk free medicine, even eating too many apples in a day can have adverse effects on our systems. Truly great doctors will do their best to minimize the consequences of the mistake so both of you (how might we…) can try again for a higher quality of life.
Titles are cool and should be respected but only if they are used for the greater good and not just for the glorification of an individual. This goes for all, even patients. Doctor’s, if you respect the institution of doctoring your patients will respect you. If I refer to you as a provider, please remember that I live a life in near constant chronic pain at levels that would send most to the ER; sometimes I don’t give a damn about titles and just want relief. Patients, being considered an advocate or patient leader is awesome. However, it is also a responsibility. We are there to help foster innovation and active listening, neither of which can happen if our mouths are always open and are ears are constantly closed. The goal is “how might we…” not “I’m right and you are wrong”.
Final thought. The doctor I saw ranting about this on Twitter is an idiot that should be ignored by all. Also, my dad was/is cooler than your dad
P.S. Good news, this post did provide me with a temporary distraction from my pain. Bad news, I’m still hurting.
