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That Which We Call a Rose…Might Not Be the Same Thing at All

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden S Lundgren
June 18, 2019

Lucille died at Ten O’clock Tuesday night, after such suffering as I hope never again to witness…Once or twice my nerve almost failed me, but I managed to stay. The poor girl’s screams might be heard for half a square and at times I had to exert my utmost strength to hold her in bed. Jaundice was marked, the skin being a bright yellow hue: tongue and lips dark, cracked and blood oozing from the mouth and nose…To me the most terrible and terrifying feature was the ‘black vomit’ which I never before witnessed…By Tuesday evening it was as black as ink and would be ejected with terriffic [sic] force. I had my face and hands spattered but had to stand by and hold her. Well it is too terrible to write any more about it.

Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue.

Both of the above paragraphs describe yellow fever. The first was written by a Memphis resident during a 19th century yellow fever epidemic in that city. The second is from the World Health Organization (WHO). Both describe yellow fever, and both are correct. Different words, but the same rose—or is it?

The language we use to describe health and disease has evolved over time. The, “Lucille,” description is characteristic of the florid descriptions of the 19th century, while the WHO language reflects the cool, clinical vernacular of what we call scientific medicine. In the latter part of the 20th century, a new linguistic model appeared describing what we might call corporate medicine.

When I began my nursing career, the people we cared for were called patients. Like many medical terms, the word patient is of Latin derivation. It stems from the verb pati, to suffer, endure, allow or submit— to undergo. Later in my career, our patients became clients. Client also has a Roman root that implies dependency. It denotes a plebian under the protection of a patrician.

By the time, I was a federal employee, a patient was becoming a consumer, which is defined by the Oxford Dictionary of English as, “A person who purchases goods or service for personal use,” or, “A person that eats or uses something.” Consumer completely loses the meanings of the previous terms. As a consumer, my relationship with a vendor is wholly transactional. I expect to pay x dollars for y goods or services, and that is all I expect. Should that be all a patient should expect from a health care professional? As both, I say not.

I encountered the way economists look at health care early in graduate school. To me, it was shocking. People, I learned, do not go to the emergency room because they are sick. Rather, they go to the emergency room as a choice among a number of consumer goods. “Shall I go out today and buy a hat, or shall I go to the emergency room instead?” Somehow, I had worked at a busy hospital emergency room without ever meeting one of the potential hat buyers.

But the hat buyer model is seductive in a society devoted to the consumption of consumer goods. Framing health care as just another one is familiar and comfortable—unless there is a stronger frame upon which to attach medical and nursing practice. Health care as commodity replaced health care as science because science is not really a scaffold that can withstand the allure of a dollars and cents model. Science does not address the moral issues intrinsic in one group of people entrusting another group with their very lives. Scientific precepts have and will come and go—economic ones too—but the center of health care, the bond between patient and practitioner, will stay central to all practice unless we allow it to break.

Shakespeare was wrong. Language counts. I am a consumer at my supermarket. Is my relationship with my health care practitioners the same as the one I have with my supermarket manager? Is that what it should be? When I patronize my supermarket, my expectation is that the primary interest of the merchant is to make money. My supermarket may provide good customer service, and I may be a satisfied customer, but our relationship is essentially adversarial. Consumers and vendors are each looking for what will benefit them the most. The relationship between patients and health care professionals (now also known as providers) should exist to benefit the patient. It is not an equal relationship. A degree of dependency is present as long the patient is in need of help.

In public administration, language is our most important tool. We need to use it carefully. When we adopt the latest consumer and provider jargon, we are describing a completely different world than that of patients and doctors. Which world do we want?

Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care. After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA. She has served as a consultant to a number of non-profit groups. Presently, she divides her time between Virginia and Pennsylvania. She can be reached at [email protected].

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