(A reflection for Doctors’ Day)
I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.
“Medical provider” is part of the Newspeak of America’s industrialized medical machine. It implies, as Hartzband and Groopman wrote in The New England Journal of Medicine, that:
“…care is fundamentally a prepackaged commodity on a shelf that is “provided” to the “consumer,” rather than something personalized and dynamic, crafted by skilled professionals and tailored to the individual patient”.
The 800-year-old word “doctor” is Latin for Church father, teacher, adviser and scholar. It infers more closely the Hippocratic and Oslerian ideal of what a physician should be like. “Doctor” is used as a title for physicians in many languages, even if other words – like physician – are used to describe the professional role of a medical doctor.
Those other words are often less than flattering in their derivation or usage. Physician, for example, comes from physic, the Latin word for natural science and art of healing, which is noble enough. Less noble is the use of the word physic for a laxative due to the common practice of purging by physicians of the past.
In Medieval times, both physicians and their commonly used blood-sucking worms were called leeches. The Middle English word leche has lived on in many languages’ words for doctors: Läkare (Swedish), læge (Danish) and lääkärit (Finnish). These words are similar to the Indo-European lepagi. It means talk, whisper and incantation and is thought by some to be the true origin of the Scandinavian words for physician.
The Russian word for physician, врач (pronounced vratch), is uncannily similar to врать, which means talk nonsense or lie, and ворчать, mutter. These similarities also harken back to ancient and mysterious rituals of physicians of the past.
The German Arzt is perhaps the most flattering of the words I know for physician; it is derived from the Late Latin word archiater (Chief physician or physician to the Court) and the Greek arch-iatros, where iatros is the familiar word for physician we use in “iatrogenic”.
Personally, if someone asks what I do, I answer “I’m a doctor”, but I never insist on what people should call me.
The language, as it changes, may accurately reflect one very powerful view of what medicine is, but neither the words nor the business model can change what patients need when they are ill or frightened. They need more than generic providers; they each need a human being with knowledge, wisdom and compassion.
Ultimately, whether others call us physicians or medical providers, it is still up to us to define our professionalism and to defend our personal standards. These things are neither generic among providers nor, as some are hinting these days, almost replaceable by technology or treatment protocols.
Star Trek’s fictional United Federation of Planets Starfleet did have a technologic replacement for their flesh-and-blood ships doctors, still nick-named “The Doctor”; installed in most Starfleet ships’ sick-bay was an Emergency Medical Hologram, EMH for short. When its transmitter was activated, it mechanically said: “Please state the nature of the medical emergency”. The EMH eventually evolved into a sort of sentient being, but it is unclear to me how patients really felt about this contraption.
What, then, is a physician? A sixty-year-old answer still says it well:
“The value of the physician is derived far more from what may be called his general qualities than from his special knowledge. A sound knowledge of the aetiology, pathology, and natural history of the commoner diseases is a necessary attribute of any competent clinician. But such qualities as good judgement, the ability to see the patient as a whole, the ability to see all aspects of a problem in the right perspective, and the ability to weigh up evidence are far more important than the detailed knowledge of some rare syndrome, or even the possession of an excellent memory and a profound desire for learning”
Dr John W. Todd, The Lancet, 1951