Patients or health-care consumers? Why the history of contested terms matters

Since the 1980s, the use of the term health-care consumer as a synonym for patient (along with its doctor analogue, health-care provider) has become commonplace in the United States. For many observers today, especially physicians, this linguistic transformation has come to represent the worst consequences of American medicine's growing market orientation. As one doctor quoted by the columnist Ellen Goodman quipped, "Every time a patient is referred to as a health-care consumer, another angel dies," while another cited by William Safire observed, "The managed-care organizations call people consumers so they don't have to think of them as patients" (Goodman 1999; Safire 2000; emphasis in original). Such visceral dislike of the term health-care consumer reflects not only the loss of physician autonomy that has accompanied the coming of managed care, but also a deeper sense of violation: a conviction that applying the base language of the marketplace to the sacred realm of the doctor-patient relationship is fundamentally wrong.