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Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts.These guidelines for care are touted as strictly scientific and objective.On rounds or in clinical conferences, doctors debated the design and results of numerous research studies.But the exercise of clinical judgment, which permitted assessment of those data and the application of study results to an individual patient, was seen as the acme of professional practice.

The relationships between doctors, nurses, or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction.Marketplace and industrial terms may be useful to economists, but this vocabulary should not redefine our profession.“Customer,” “consumer,” and “provider” are words that do not belong in teaching rounds and the clinic.Recasting their roles as those of providers who merely implement prefabricated practices diminishes their professionalism.Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring.Furthermore, the term “provider” is deliberately and strikingly generic, designating no specific role or type or level of expertise.Each medical professional — doctor, nurse, physical therapist, social worker, and more — has specialized training and skills that are not recognized by the all-purpose term “provider,” which carries no resonance of professionalism.The consumer or customer is the buyer, and the provider is the vendor or seller.To be sure, there is a financial aspect to clinical care.We are in the midst of an economic crisis, and efforts to reform the health care system have centered on controlling spiraling costs.To that end, many economists and policy planners have proposed that patient care should be industrialized and standardized.

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