What would you call them, then?

In looking for this article about the arduous task of losing weight (which is now Thursday’s post topic), I came across an irritating little essay at the Well blog at the Times.  In it, Dr. Danielle Ofri gripes about a couple of words she doesn’t like:

“Health care provider” came into vogue as the catchall phrase and was quickly truncated to just “provider.” The term does have its upside, helping to minimize hierarchy. History has shown us that medical hierarchy usually serves more to stomp on underlings than to provide leadership. In fact, physician assistants, nurse practitioners and doctors have more similarities than differences in their day-to-day interactions with patients, even as they come from unique backgrounds and bring different strengths to the table.

Still, the term “provider” has never stopped irritating me. Every time I hear it — and it comes only from administrators, never patients — I cringe. To me it always elicits a vision of the hospital staff as working at Burger King, all of us wearing those paper hats as someone barks: “Two burgers, three Cokes, two statins and a colonoscopy on the side.”

The other term that makes my skin crawl is “hospitalist.” Whenever I do full-time inpatient work (in contrast to outpatient clinic work), I’m called a hospitalist. What the heck is a hospitalist — someone whose specialty is taking care of hospitals? In my mind I see a car repair shop, with the entire hospital building hoisted on the lift, and all the — ahem — providers underneath with wrenches, drills and oilcans in our upraised arms.

What makes the essay so irritating is that Dr. Ofri doesn’t suggest anything to replace the words she doesn’t like.  And we need something to denote the meanings behind those two words.

It’s not that I don’t sympathize with Dr. Ofri’s position.  When drawing up sides in the usage wars, put me over with the prescriptivists.  I think a language is best served by having words that convey the meanings behind them clearly and concisely.  It drives to me to distraction every time I hear the phrase “very unique.”  (We don’t need another synonym for “unusual”!  We have lots of them!  We do need a word that tidily conveys the concept of “the only one in existence”!  Aieeeeee!  Wait… where was I?)  But even the most ardent prescriptivist has to allow for language to expand when new ideas emerge that demand expression.

It’s easy to find examples that are absurd or unlovely on their face, but that have been accepted because they do the job.  Take any of a number of kludged-together terms we use for people with certain addictive behaviors — shopaholic, chocoholic, etc.  All of them are the bastard children of “alcoholic,” derived from the actual word for the substance abused.  By contrast, nobody is addicted to “shopahol” or “chocohol.”  But because our burgeoning culture of addiction lacked a cogent means of describing different types of additive behaviors, “-aholic” became the understood and accepted suffix.  It filled a void.  (See also “-gate” to indicate a political scandal, even though Watergate had nothing to do with water.)

I agree that “hospitalist” is a utilitarian and charmless word.  There’s no such thing as “hospitalism” or “hospitology.”  But changes in the contemporary practice of medicine demanded that some word be created for physicians who deliver care primarily in inpatient settings.  More and more primary care providers have started handing over the care of their patients upon admission to the hospital, and “hospitalist” was the term that sprang up to describe the people who did that job.  While I think this phenomenon has its pluses and minuses (my practice retains the inpatient care of our patients as much as we can), it is nonetheless the lay of the land now and we need a handy way of describing the providers who deliver that kind of care.  If not “hospitalist,” then what?

So, too, with “provider.”  I happen to think it’s not so bad.  As you can see, I use it myself.  But for those who share Dr. Ofri’s dislike of the word, what else would they suggest to take its place?  It’s not just that it helps minimize hierarchy.  “Physicians, nurse practitioners and physician’s assistants” is far too unwieldy to be used repeatedly.  Like it or not (count me with the former), NPs and PAs are here to stay, and we need a word that encompasses them when describing the category of professional that diagnoses and treats illness, unless the discussion at hand is strictly limited to doctors.  Don’t like “provider”?  OK, then what should we use instead?

If we didn’t need those words, they wouldn’t have gained traction the way they have.  My problem with Dr. Ofri’s essay is that it laments the solution while eliding any discussion of the problem.  As a physician at a fine institution like New York University School of Medicine (holla!) and a writer for the New York Times, she is uniquely positioned to offer linguistic solutions of her own.  In the meantime, “provider” and “hospitalist” will have to do.