Dear specialist: You’re awesome, but please stop calling me a provider

To my specialist colleagues,In over 30 years of family practice, when I have been uncertain about a diagnosis you’ve been there. When I needed some advice on best treatments, you’ve been there. You’ve helped me and my patients, and you deserve many, many thanks for that.As with all things, there have been some ups and downs over the years (we really need to talk about the “go see your family doctor to have your staples/sutures removed” thing). Perhaps it’s because I work at a fairly small hospital with generally collegial colleagues, but I genuinely have positive feelings about our relationships and interactions.There is, however, one thing that is starting to creep in to the vernacular that needs to be addressed before it goes too far. I’ve noticed it increasingly in reports from specialists. It seems to be particularly endemic in notes from the emergency medicine specialists and younger specialists.Read: Dr. Sohail Gandhi: CFPC fails to learn its lesson, makes the same mistake againIt is the unfortunate tendency to use the highly offensive and derogatory term “provider” when referring to the family physicians. As in “the patient should follow up with their primary care provider.”A couple of months ago, I attended the biennial menopause society update (yes, the same one where I discovered family physicians were giving up). At one of the small breakout groups, I happened to sit with a couple of my specialist colleagues. We were talking about how to handle various clinical scenarios, when I noticed both of them using this abhorrent term.My personal observation (and I suspect I’ll get in trouble for saying this, but I’m going to say it anyway), was that the two of them looked like they weren’t even born when I entered medical school. It’s a credit to them just how involved they were in their hospital and community and patient advocacy at such a young age. As I understand it, they had been told that “primary care provider” was the appropriate new terminology to use.I don’t really fault them. They were not aware of the negative connotations involved in that term or how objectionable it was. In fact, I credit both of them with being very open to change when I spoke to them about this.What exactly is the problem you may be wondering? What’s the big deal about using the term provider?Because language matters. Words matter. Definitions matter. Just as it is highly reprehensible and dehumanizing to use the word “client” when referring to a patient, it’s pretty offensive to use the term “provider” when referring to a family physician.The term “physician” has meaning. It denotes a person who is entrusted to help you heal. It signifies a sacred bond between the healer and the sick that dates back to Hippocrates. It infers respect and dignity. It attributes professionalism, honour and morality. It automatically speaks of the implicit trust that patients have.The term provider, in healthcare, is egregious and appalling. To quote an excellent article by Jonathan Scarff:“The word provider does not originate in the healthcare arena but from the world of commerce and contains no reference to professionalism or therapeutic relationships.”He goes on to state:“This terminology suggests that the clinician-patient relationship is a commercial transaction based on a market concept where patients are consumers to be serviced.”I could not agree with him more.One of the things that the bureaucrats who run healthcare have long resented is the respect that physicians have from patients. Despite all of the attacks against physicians on social media, and even from official government types like RFK Jr in the states, physicians consistently continue to be shown to be among the most respected professionals out there (yes, we are behind nurses). We receive these high rankings based on the proven belief that we are honest and adhere to ethical behaviours and high standards.I firmly believe this is why bureaucrats have tried to bring in new terminology to describe physicians. They know that if we speak out against their brilliant ideas to “fix” healthcare, physicians will inherently get more trust than bureaucrats. I’ve seen the resentment of physicians firsthand at a bunch of bilateral meetings between the OMA and the ministry of health. Trust me, it’s there, both implicitly and in some cases, very explicitly.So the bureaucrats, under the guise of “inclusivity” or “patient centredness” or some such thing, are now introducing the term “provider” to diminish the significance of our roles. Their goal is to curtail our value in the eyes of the public, so when we call out their (many) mistakes, there will not be implicit trust in what we say. Think about it, which sentence below has more impact:“Ontario’s providers speak out against government’s health proposal”or“Ontario’s physicians speak out against government’s health proposal”Get the point? I beseech my specialist colleagues to not fall into this trap. Being a physician (as you know) is a sacred responsibility that all of us take seriously. We routinely make life altering suggestions to patients and have a strong bond with them. Our role in their lives is not a commercial transaction. We do not treat patients as consumers who need to be managed. As the section of general and family practice points out:“This term (provider) devalues the training, expertise, and vital role we play as physicians in the healthcare system. Family physicians are not providers; they are physicians.”.So I ask you my specialist colleagues, the next time you write an emergency department note, or a consult note, be mindful of what you write. Recognize and respect the value of the person you are sending it to. Ignore the bureaucrats’ self-serving machinations when they try to change the terminology.Tell the patient to follow up with their family physician. (Except for the staple/suture removal—you can do that yourself).Yours truly,An Old Country DoctorDr. Sohail Gandhi is a former president of the OMA and opinions are his and not necessarily the opinions of the OMA Board. This article is a reprint from his blog site: justanoldcountrydoctor.com.

Dear specialist: You’re awesome, but please stop calling me a provider

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