Can we be smarter than Walmart?


I’m hoping this post does not circulate to certain foundations making major healthcare grants for consumer engagement such as one we recently applied for. So don’t go forwarding this willy nilly; keep this among us humans. I think I’ll even hide it beneath some nature pictures for safety.

Maybe its just being snowbound in a cabin, but I’ve had it with calling human beings “consumers” as if that is a promotion of some sort. The curious habit has even infected healthcare organizations who started describing the people in their care as….consumers. This is more common among those receiving stigmatized outpatient treatment, such as mental health services. The idea is that we should remember patients are active decision-makers and purchases of services, just as honorable in their own way as somebody choosing Target over Walmart.

Treating people with as much decency as Walmart seems like a low goal to aim at. Human beings in a relationship of caring and treatment are in a more complex dance of intimate exchange than Walmart understands.

Somewhere between 17-19% of economic activity in the United States currently involves health services, so there is a lot of consuming going on. But even when the activities do involve people paid to be present, the relationship is poorly understood as consumption. Larry Pray, who may be my very smartest friend, posted about his visit this week with his mother who is suffering from dementia and is in the daily care of people who are not his family. “It is the last day of my visit to the nursing home in Madison. The Memory Care unit to be exact. I am touched, once again, by the kindness of the staff who have learned how to lovingly live with confusion, how to turn caught thoughts to another topic, how to comfort, and how to laugh. Doctors are great, but here where folks actually live it is the staff-on-duty who speak of life.” (http://www.larrypray.com/?p=2024)


It not just impolite or impolitic to describe such relationships as consumption; it makes everyone involved stupid and less able of playing their role. Those closest to the work of healing, the family, are reduced to functional bargains because they work for free. Physicians and nurses are similarly diminished, but paid. Hospital leaders are no more than marketers and distributors of services. Leaders of caring congregations are reduced to gullible partners, lending their skills to doing others’ work without pay. I can assure you that the Le Bonheur staff in the picture care way, way beyond what money can explain.

Thinking of people only as consumers blinds us to the extent that the “health system” is constrained to only institutions and people who do things for money. All professionals, whether medical or those in “public health” are diminished to mere employees and providers of monetized exchanges.

No wonder we have trouble understanding the complex journey to and through our institutional space that is governed by many moments of discernment, trust, judgement, expectation, hope and fear. No wonder we are surprised when, for reasons of race or religion, people fail to act like we think rational consumers would do.

Health is not consumed or provided, it is the name of how we live together. We do not engage consumers, we listen to each other.


So why not call ourselves members? Why not citizens? Why not extended family, brothers and sisters?

Our electronic medical record at Methodist is the hard wiring that connects every member of the our treatment system with those in our care. It keeps track of every pill and procedure for every person involved, including many things nobody pays for, such as spiritual care. Our system is distinctive in that it also has a page allowing physicians to recommend actions to be offered up by a patients’ congregation, as a natural part of the healing system. We have the capacity to help all involved in the caring process to be informed and guided by the others. Sort of like humans might do.

Even those of us most highly paid “providers” will experience our time of dependency. We hope that when we do, we will be engaged not as a consumer, but listened to even as a mother, father, sister, brother, friend.

– Posted on the journey

About garygunderson

Vice President, Faith Health, Wake Forest Baptist Medical Center in Winston-Salem, NC. Author, Leading Causes of Life, Deeply Woven Roots, Boundary Leaders and Religion and the Heath of the Public. Secretary, Stakeholder Health (Health Systems Learning Group).
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