AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. August 2001, Volume 3, Number 8.

From the Editor

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A Physician by Any Other Name

The editor believes the patient-physician relationship is impacted by naming conventions for physicians.

Audiey Kao, MD, PhD, and Karen Geraghty

MENTAL HEALTH AND WELLNESS CENTER
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Equal Opportunity Employer.

In other social relationships, such as those between patient and physician (or consumer and health care provider, or customer and mentalist in the future), the names we use to identify individuals and their roles also matter; they reflect and shape the identities, obligations, and expectations of the participants.

In medicine, terms that refer to those we seek out when we are sick changed little until very recently. The term "physician" has been around since the days of Aristotle, and derives from "physik," an ancient Greek word for "nature." Physicians were those engaged in the study of the natural world. Hippocratic physicians understood illness as part of the natural order (as contrasted with those healers who believed that illness was part of the supernatural order—punishment from the gods) and sought explanations for illness in the physical world. They constructed a system of elements (earth, air, fire, water), qualities (dry, cool, hot, wet), and seasons (fall, winter, summer, spring) and related them to constituents of the human body, known as the humors (blood, yellow bile, phlegm, black bile).

The term "doctor" came into usage in the early Middle Ages (13th - 15th centuries) when the education of physicians shifted to the university setting. "Doctor" signified a physician who had received formal university training (usually with a heavy emphasis on the teachings of Aristotle and Aristotelian logic). Thus if one wanted to be technically correct in applying the terms "physician" and "doctor," one would say that Hippocrates (who lived around 400 BCE) was not a doctor, although he was a physician.

Beyond etymology, an individual who is sick and seeks the care of a doctor has certain expectations about this interaction and the professional obligations of the physician. Patients expect their interests will be put above those of the physician. They expect their doctors to keep sensitive information private and confidential. Patients expect their physicians to treat them with empathy and compassion, especially when that is all the physician has to offer. And patients expect their doctors to act as caregivers, and not as purveyors of a health care service.

More and more today, physicians are referred to as health care providers, a name change that is anything but benign. In our increasingly market-driven health care system, the use of such terms as "health care provider" supports the notion that the interaction between patient and doctor is no different than that of any other transaction between a buyer and seller. In this commodification model of medicine, a health care provider is guided by a market ethic, and is not bound to the professional ideals and obligations that have defined medicine for centuries. To those (presumably the young and healthy) who may say that the old model professional physician reflected in our lexicon is outdated and unnecessary, I can only say that I hope you never experience true illness and the inherent vulnerabilities that this creates. Caveat emptor.



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