Landmark legislation was signed into law by Georgia Governor Brian Kemp on May 2, 2023. Senate Bill 197, the Health Care Practitioners Truth and Transparency Act, is likely the most comprehensive state law promoting exactly what its name promises: truth and transparency, in this case regarding health care credentials.
Informed consent for a patient means, in part, that the patient understands exactly who is treating them. This new Georgia law is a huge step in the right direction. But there is a glaring truth and transparency problem within our health care language that remains pervasive and should be addressed: the word “provider.”
Language is a powerful tool. Language doesn’t just convey thoughts; it shapes thoughts.
The word “provider” has no positive connotations within health care. There is some controversy regarding its origins related to health care. Some reports link the word back to World War II, when the Nazi regime stripped Jewish physicians of their titles, branding them “behandlers” (translated to “provider” by some) instead of physicians. Regardless of any translation concerns, the intent was clear: to reduce the education and training of physicians to something less, to obscure their expertise, to dehumanize them and demoralize them.
Other reports note that “provider” was introduced in the 1960s as part of Medicare. The word was used in the sense of a contractor being paid for paid for delivering health-related products and services. Over the following decades, the word grew to include any professional caring for patients. Here, the word “provider” is used to create a transactional relationship between physicians and patients, and it has the effect of dehumanizing health care.
No “have it your way health care”
Most patients do not want to be seen as consumers. They want to feel empowered and be a partner in their own care, but they do not want to “shop around,” especially when it comes to their primary care, where an ongoing, trusting relationship is key.
Our value as physicians is not based on what we provide. It is based on the relationships we form with our patients, the trust and expertise we employ, and the personalized care we give. We are so much more than the boxes we click, the medications we prescribe, or the tests we order. What we do provide is not meant to satisfy some market demand, but to augment our diagnostic acumen and best serve our patients in a dynamic, individualized way.
Blurring the lines
Patient care today is typically delivered by a team of professionals, each serving our patients in our own unique way, based on our distinct training, education, licensure, and expertise.
Who, exactly, is that white-coat-clad “provider” that just walked out of your father’s hospital room? Unless they told you specifically, you wouldn’t know. They could be a physician (MD or DO), nurse practitioner, physician assistant, or any of the other professionals on a health care team.
Imagine calling Peyton Manning a “pass provider,” or your attorney a “law provider.” No physician ever dreamed of going to “provider school.”
The word “provider” blurs professional lines, making everyone on the health care team seem homogenous and interchangeable. The nomenclature strips professionals of their earned titles and ignores their unique training, education, credentials, and expertise.
Depersonalization in health care
Being referred to as a “provider” is offensive to many physicians and other health professionals, who find the word demeans their profession, ignores their level of training, and belittles their unique contribution to care. This sort of depersonalization causes moral injury, which contributes to burnout.
In 1993, William Safire shared these prescient words:
As a physician, I am somewhat distressed at being called a health care provider,” writes David A. Worth, M.D., P.A., of Union, N.J., “rather than a doctor, a physician or a professional.” He suspects he knows why the new nomenclature is being adopted: “It is easy to regulate providers but more difficult to regulate doctors, as people have a mental picture of their own doctors’ care. Let us not devalue our physicians by terming them providers. This is just one step away from limiting what they say and depriving them of their ability to make professional decisions.”
When physicians speak up regarding patient safety or transparency concerns, or even ask not to be called “providers”, they are often labeled “disruptive” or accused of creating a “hostile work environment.” Dr. Worth was right, and he wrote those words three decades ago.
Changing the lexicon
How can we remedy this “provider” situation? We must change our language and root out the word “provider” from every connection to individual health care professionals.
1. Every professional organization should adopt policies banning the use of the word “provider” to describe health care professionals. Many large physician organizations have policies maligning the word “provider,” some even banning the word from their publications and conferences. All medical professional organizations should adopt such policies and actively enforce them in every form of communication.
2. Hospitals and other health care facilities should encourage transparency by creating and enforcing policies to remove the word “provider” from usage.
Recognizing the potential for patient confusion and the moral injury it causes physicians should be reason enough to remove the word “provider” from hospitals. EHR systems should be configured so that each professional is accurately identified by their licensure, not as a “provider.”
3. Health care staff must be trained to use individual titles, rather than the word “provider.” Staff should use titles and licensure to describe health care professionals at their workplace.
4. Patients should be empowered and feel encouraged to ask about credentials. No patient should ever be shamed for asking for clarity of health care credentials, and they should never be confused by “provider.”
In this era of instant access to information, we must be constantly aware of the “illusory truth effect”: when a statement is repeated enough, we tend to believe it, no matter how false it may be. “The effect is so powerful that repetition can persuade us to believe information we know is false in the first place.”
If ever words have mattered, it is now.
Carmen Kavali is a plastic surgeon.
