Constrained Collaboration in Patient Consumerism

One of the marked changes in the social organization of healthcare in the United States over the past 50 years has been the increase of patient involvement in the medical encounter. Increased patient involvement has been described in various ways, including as patient empowerment, changes in patienthood, and patient consumerism. While many analyses focus on tracing the development of patient involvement, this paper examines patient consumerism from the perspective of the medical profession. I find that patient consumerism is anticipated and managed by physicians, and moreover, that medical trainees are overtly taught to manage patient consumerism. As described in earlier work, a process of constrained collaboration (Vinson 2016) can help us understand the ways in which this management occurs. Moving this earlier work forward, in this paper I discuss physician attitudes toward patient consumerism and how these are transmitted to medical trainees during their education. Thus, in order to understand how and why patient consumerism is managed by health care providers, the analysis draws on medical education, where teaching is done by practicing clinicians. This analytical window into the thought processes of practicing clinicians allows insights into what physicians think consumerist patients are like and how they think physicians should properly manage them. Understanding this process has implications for theories of professions that imply that physicians are being steadily deprofessionalized, as well as for theories of professionals and patients that imply that patient consumerism is entrenched and unstoppable—these trends may not be as operative in the local doctor–patient encounter as broader medical sociology analyses imply.