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Customer or Patient: the Word You Use and the Matter of Trust

The following blog post is taken from remarks by John Boornazian, MD, chief medical officer at Huggins Hospital in Wolfeboro, CT.

Most of us in healthcare have strong views regarding the terms “patient” and “customer.” I can remember filling out an application form for a health insurance company, and they asked how many customers I saw each week. I was quite offended, so I crossed out customers and wrote in patients.

I recently had the pleasure of being part of a very inclusive process to develop a three- to five-year strategic plan for my hospital. This group of employees, administrators, board members and physicians spent a long time discussing these terms.

The Meaning of the Word “Patient”

As a physician, the word patient really means something to me. Over the past few years, however, I have come to appreciate the thinking around healthcare customers and understand where using that business term is at times more appropriate and helpful.

“Patient-physician relationship” is first ingrained in medical school and has an important legal meaning.  The AMA code of medical ethics speaks to this: “The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering. The relationship between a patient and the physician is based on trust, which gives rise to the physician’s ethical responsibility to place patients’ welfare above the physician’s own self-interests or obligations to others, to use sound judgment on the patient’s behalf, and to advocate for their patient’s welfare.”

When we speak of a physician-patient relationship, we know that relationship is like the relationship between patients and other professionals in the hospital, including nurses and therapists.

A Trusting Relationship in Healthcare

I had the opportunity, years ago, to witness this trusting relationship. A patient in her mid-80s came to my office with newly recognized atrial fibrillation. After the evaluation, I told her the best approach was to have an electrical cardioversion. She agreed, and it was scheduled. In the ICU, she asked me several questions, and with each answer she looked at the nurse, whose name was Nancy, standing on the other side of the bed. She would not avert her gaze until Nancy responded either verbally or with a nod of approval. At the end of her questions, I stated, “it’s clear to me whom you trust the most—the nurse!” She laughed and said, “You’re darn right!” This woman was my patient, but she was also Nancy’s patient.

Consumerism is a relatively new concept in healthcare, but it is evident everywhere. When a patient decides to establish with a practice based on evening hours or online scheduling, or goes to their portal to ask questions or check their labs, they are acting like customers. When they decide to initiate a virtual visit with a physician they’ve never met, they are acting like customers. When they look for a hospital’s CMS star ratings before having elective surgery at that institution, they are being customers.

A reputation of excellent medical care and strong service will bring customers to us. When we develop a trusting relationship with them, they become our patients.

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