The Hidden Businessperson: Money’s Conspicuous Absence in the Concept of “Doctor”

(Unknown Wikimedia Commons User / Wikimedia Commons)

The field of medicine is often portrayed as the most altruistic career set. But behind the illusion lies a business like any other, with the same financial concerns and limits as a big company. (Unknown Wikimedia Commons User / Wikimedia Commons)

I recently searched Google Images for the keyword “doctor.” The page of results was flooded with attractive (predominantly white and male) people decked out in the classic white coats and stethoscopes. Dominating the pictures were broad, reassuring smiles and warm, kind eyes. These people really looked like there was nothing in this world they would rather do than make me feel better, curing any sickness with the perfect mix of modern medicine and hugs. The excessively good-looking population of Google Images is only a brief glimpse into a serious reality: the idea of an altruistic physician is pervasive, but is often an illusion.

When we talk about doctors, we use a specific set of verbs to describe what they do. They give. They aid. They care for. They help. They even treat. The word therapy actually comes from the Greek “therapon” meaning attendant or servant. Loved ones in the hospital are “given therapy” in various forms. They’re not “sold therapy” – are they?

The language used in the world of medicine is dripping with altruism, directing our understanding and framing expectations for the future. Altruism is not, however, an operational part of the medical profession. Any role altruism played in the relationship between a patient and his or her doctor gave way to rapid commercialization long ago. While I would never try to claim that doctors are, as a rule, selfish or unsacrificing people, we must acknowledge that they don’t “give” treatments. They sell them. The structure of health care today is that of a business, not a charity. Why, then, do we say things like “the doctor gave me some morphine” but not “the grocer gave me some bananas?”

To approach this issue solely from a linguistic perspective is not enough. It seems perfectly natural, after all, to say that the hairdresser “gave me a haircut” even when it’s clear that these services are paid for. This brings to light another mechanism by which the illusion of altruism veils the business of health care. The last time I went for a haircut, I went to the ATM first for some cash. At the end of my appointment, I handed it to the hairdresser. When was the last time you saw patients in hospital beds digging around in their wallets for exact change to pay for the fresh bandages on their stitches? When doctors finish examinations they don’t ask “credit or debit?”. They ask “Do you have any questions? Do you need anything else?”. The doctor as an individual is kept entirely separate from his or her fees, interacting with the patient only on the level of care-giving. Financial compensation is dealt with at another time and, more importantly, by someone else.

Why do we allow ourselves to carry on in a model of health care that misrepresents the role of the doctor both linguistically and practically? In my opinion, it is because the commodification of one human aiding another makes people distinctly uncomfortable. Altruism is a quality we want to see; the model of a physician as a businessperson with skill and knowledge capitalizing on the desperate sick is not morally appealing. However, ignoring something out of discomfort is rarely a good idea, and a system that promotes vendors masquerading as altruists should certainly be reexamined. Language and practices should reflect the patient as a consumer of goods and services, because no matter how unpleasant that may be, it is the reality.

For interesting (and disturbing) information on patient/consumer vulnerability check out TIME magazine’s recent article “The Bitter Pill.”

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