Common Sense

An Emergency Physician is NOT a Provider


Issue: January/February 2021

Author: Lisa A. Moreno, MD MS MSCR FAAEM FIFEM
President, AAEM

 

I have had a real issue with this word almost since its introduction into medical vernacular. I often plagiarize a physician’s response I read sometime ago on social media, “Sorry, I never went to provider school. I went to medical school.” When I was a child, we used to respond to hurtful comments about our racial and ethnic backgrounds with a pithy jingle, “Sticks and stones may break my bones, but words can never hurt me.” How untrue this was then, and still is now. We have evolved as a society to the understanding that WORDS ARE POWERFUL, and what we call ourselves and each other, how we describe a given situation, very much matters and can very much hurt or help our interpersonal relationships.

The word “provider” when used in reference to a health care professional has its origins with insurance companies and government agencies who seek to create in our patients the attitude that there is no difference among health care professionals, and so if they have seen a “provider,” they have received the highest level of care and their health concerns have been resolved and/or are being managed appropriately. The term gained popularity as it has been taken up by corporate medical groups with the same intended outcome. These “vendors” of medical care, as they call themselves, all can save lots and lots of money when patients are treated by “providers.” 

The problem is that all “providers” are NOT equal and that allowing, or leading patients to think so is dishonest and lacks integrity. AAEM’s mission statements stand clear that a board certified emergency physician is the only definition of a specialist in emergency medicine and that every patient in the world is entitled to this level of care when faced with a medical emergency. Our mission includes the support of EM residency training and CME, as well as the development of EM as a specialty world-wide. Our EM Workforce Committee, under the leadership of Dr. Marcolini and Dr. Vieth, has developed public statements based on hard facts to demonstrate that there is a difference and that it does matter. 

The word “physician” is defined by the Oxford Dictionary as “a person qualified to practice medicine.” (italics mine)1 and the Merriam Webster dictionary defines it as “one educated, clinically experienced, and licensed to practice medicine.”2 Clinically experienced, qualified, and licensed to practice medicine is very different from clinically experienced, qualified, and licensed to practice physician assistance or any form of nursing. As the EM Workforce Committee points out, some nurse practitioners are entirely trained online, with no new clinical experience required to earn this advanced degree. 

The origin of the word “physician” comes from both French and Middle English, meaning “one who practices the science of healing.” The linguist Janus Bahs Jacquet points out that a literal translation connotes “relating to that which is.”3 This derivation implies a grounding in truth, as we relate to our patients in the context in which they exist, making our responsibility for them far greater than a mere commitment to their chief complaint. Our Hippocratic Oath mandates that we live in purity and holiness.4 The Oath of the Hindu Physician, the Daily Prayer of Maimonides, and The Thousand Golden Remedies (China) all command the physician to be committed to truth and integrity in all aspects of his or her life.5 In the days in which Ibn Sina wrote the Canon of Medicine, physicians were required to pass examinations not only in the natural sciences and pharmacology, but also in religion, fine arts, law, philosophy, astrology, and mathematics. It was accepted that since the physician dispenses advice and treatment that impacts every aspect of a patient’s life, s/he must be a scholar and a person of wisdom to perform that role. And of note, female physicians were not a rarity in these Islamic medical universities.6 The Declaration of Geneva, developed after the horrific medical experimentation and abuses committed during the Second World War and to which I swore on my graduation day from medical school, states, “I solemnly pledge myself to consecrate my life to the service of humanity…The health of my patient will be my first consideration…I will maintain the utmost respect for human life…even under threat and I will not use my medical knowledge contrary to the laws of humanity…”7 These are not the obligations of a provider. Being a physician is not a job. This is a vocation. It is a profession in the least. It is an awesome thing to have a human being place his/her most precious gifts—life and body—into our care with complete and unwavering trust. And there are many of us today who still believe that we are accountable to the Creator of these lives and bodies for the manner in which we care for them. 

I am not now, never have been, and will never be a provider. I am called to be a physician. It is my privilege and my responsibility. It is one of the most important purposes of my life. I worked extremely hard to become a physician, and many others worked hard for me to become a physician, including but not limited to those who taught me and the family that sacrificed for my studies. And truthfully, I continue to work hard, and I continue to be taught and to learn, and my family continues to make sacrifices. I will not tolerate the obliteration of the integrity of my profession using a word that seeks to make me a generic entity. And I believe that every nurse, physician assistant, psychologist, midwife, plumber, electrician, pilot, teacher, priest, and rabbi should be PROUD of what they have chosen to do with their lives and should insist that they be called by the noble name of their profession. 

Because words matter, once we allow ourselves to be called “providers,” we will accept ourselves as providers, and we will indeed become providers. Medicine will become a job, and the biggest losers will be the patients whom we will no longer put first and no longer serve with integrity and dedication. We will no longer hold ourselves responsible for social injustice and political immorality. We will no longer feel responsible to educate our patients about gun violence, drug abuse, and respect for nutrition and preventive measures. Slowly, we may come to regard profit, through put time, and billable services as more important than making the right diagnosis, ordering the necessary studies without regard for insurance status, delivering bad news with compassion, and taking the time to ensure that patients have a way to fill their prescriptions and a safe place to live. We will become part of the medical industrial complex, owned by the vendors of health care, providers for their profit-making industry. I will remain a physician, proud of the standards and the mission and vision of AAEM, proud to be part of an organization that upholds honesty and integrity. Thank you for being part of this with me. 

References

  1. www.dictionary.com
  2. https://www.merriam-webster.com/dictionary/physician
  3. http://ec2-23-21-117-9.compute-1.amazonaws.com/topics/body-brain/segment/01/28/2011/science-diction-the-origin-of-physician.html
  4. https://en.wikipedia.org/wiki/Hippocratic_Oath
  5. Distributed to me at my graduation from medical school; copies available from me on request
  6. The Physician by Noah Gordon is a historical novel that accurately describes medical training during what Europeans called the Dark Ages. This was a magnificent age of learning in the Middle East. As an aside, the movie of the same name does not do the book justice in my opinion.
  7. https://www.wma.net/wp-content/uploads/2016/11/Decl-of-Geneva-v2006.pdf

 

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