Words Matter: What Is a Consumer?

Words matter. They convey our thoughts, they illuminate our understandings, and they can comfort or not. Many people use the word “consumer” in the context of health care without thinking about its meaning. I urge you to think more deeply and clearly about its meaning before you use it again.

According to Miriam-Webster, a consumer is “one that (sic) consumes, such as: one that (sic) utilizes economic goods. E.g., Many consumers make purchases on the Internet” (https://www.merriam-webster.com/dictionary/consumer). To consume is “(a) to do away with completely; (b) to spend wastefully; (c) to eat or drink especially in great quantity; (d) to waste or burn away” (https://www.merriam-webster.com/dictionary/consumes). A consumer, then, has a pejorative meaning, one who is artificially separated from production or productive activities. Is that what you want to say when you use the term “health care consumer”?

The concepts of consumption and production, as separate and distinct activities, were developed long ago by economists, who attempted to quantify economic activities (Vargo and Lusch 2004). This perspective is no longer useful in explaining the cocreation of value, because it holds the potential to create an antagonistic relationship between providers and patients. Why? Because when one produces something of value, and another “consumes” it, value is defined exclusively by the producer. “We do all this great stuff here at XYZ Hospital, and often the patient just comes in and spoils it.” This is fundamentally wrong, and you instinctively know it.

So what is the proper term? More importantly, what is the proper perspective that can guide you into thinking about this issue in a more appropriate manner? I argue that experiences are coproduced by patients, providers, families, caregivers, and potentially many others. Value is always cocreated between at least two parties, most often among multiple parties (Black and Gallan 2015). Health care organizations cannot create value without patients. At most, they create value propositions that invite patients to engage with their services. Only when patients do so, and only when interactions go well, can value (as health and well-being), be cocreated. That is, patients experience health care in such a way that creates a better state for them (progression toward a goal, improved well-being, improved health, etc.).

Likewise, when a health care interaction goes well, a health care organization can capture value in various forms as well. For instance, it can capture financial value (money), it can capture value as employee fulfillment and satisfaction, and it can capture positive feelings and attributions toward its brand and organization (positive word-of-mouth and loyalty behaviors). All of these are desirable outcomes for health care organizations.

So when is a person a patient? A customer? Something else? My position is that people assume multiple roles in different situations, and thus must be treated accordingly. One health care clinician, who I fail to recall, put it thusly: “When a person is horizontal, they are a patient. When a person is vertical, they are a customer.” This is a bit simplistic, but, like all pithy sayings, has an element that rings true. I am not trying to tell clinicians that my perspective usurps their clinical domain; rather, I am rendering unto them what is theirs. When a person is being evaluated clinically, they are a patient, with all the rights and responsibilities that conveys. However, if clinicians, clinics, organizations want positive evaluations, reduced readmissions, bills paid on time, reduced no-show appointments, etc., they should understand that people have choices, degrees of freedom, and a voice. At that time, it is appropriate to consider a person as a customer. Increasingly, people are exercising these rights through technology. This does not make one a “consumer.” It only shows that a person is a complex individual, who acts in different and interesting ways.

When we are allowed to be labelled as a “consumer,” we are permitting ourselves to be pigeon-holed as one who can only offer economic benefit to an organization. We are more than that. Indeed, we are the very people who the health care system is designed to serve (evaluate the meaning of “service” too). Don’t allow yourself to be defined by this term: likewise, don’t define your patients as such. They are whole people, who act in a variety of roles throughout their health care experiences and their lives.

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P.S. I also have an issue with the term “THE patient experience.” The term “the” creates an understanding that there is a singular experience that is perfect. Or that patient experience is an object that is separated from the person who is experiencing it. It objectifies the experience, and artificially separates a patient from the timeline of her life. Instead, I urge you to use the term “patients’ experiences,” because it inserts humanity into the term. It automatically urges us to think about patients as people, and experiences as their own. Think of it this way: “Improving THE patient experience” is much different in meaning from “Improving patients’ experiences.”

References

Black, Hulda G. and Andrew S. Gallan (2015), “Transformative Service Networks: Cocreated Value as Well-Being,” The Service Industries Journal, 35 (15-16), 826-45.

Vargo, Stephen L. and Robert F. Lusch (2004), “Evolving to a New Dominant Logic for Marketing,” Journal of Marketing, 68 (1), 1-17.

 

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