It’s fashionable – and beyond that, irresistible — to mock the increased use of business-speak in healthcare, and seems almost heretical to defend, or even explain, this practice. Nevertheless, I’d like to give it a shot.
First, though, a few of my favorite examples, from Lisa Suennen (here), Marty Samuels (here), my own contribution (here), and, though not specifically healthcare-related, Joe Quennan’s brilliant recent WSJ commentary (here). I’d also recognize Martin Kihn’s brilliant “House of Lies,” the basis for the popular Showtime series.
It occurred me that this sort of critique may have become a bit too reflexive when I read a recent article featuring a linguist critiquing the tech industry for use of obfuscatory language that employs words like “pattern matching” instead of “stereotyping” although, as the linguist points out, “there is no difference at all in the denotative meaning.”
The guy’s probably right, of course, but “denotative meaning” – really? After not much thought, I recognized just how much chutzpah it takes for a linguist, of all people, to critique others for using excessively complex language; has he tried to read anything in his field’s own journals? (It’s probably also why language experts like Harvard’s Steven Pinker, who can express difficult concepts with disarming ease, are deservedly popular.)
The truth is that practitioners of almost any field rely on language that is often regarded by outsiders as needlessly complex. Physicians may make fun of the business-talk, but few would hold up the language of medicine as the best example of jargon-free communication.
The real issue, I think, is that, while you can understand why linguists may have their own jargon, and physicians, theirs, the specialized language of business seems especially maddening because its often perceived as fundamentally hollow, an edifice of words that signify nothing.
In some cases, business jargon really is empty – a concern I shared here, and a critique that I suspect applies equally to a range of other disciplines, including science and medicine, where complex jumbles of words often obscure an absence of fundamental understanding.
But it’s also possible that are aspects of business-speak that seem silly to the uninitiated, yet actually make sense to managers trying to solve problems. It some cases, the terms may seem strange, unfamiliar, or excessively formal, yet these words often helps communicate essential business concepts quickly and efficiently to others in the organization.
It’s amazing how rapidly some of the words can become second nature. I caught myself starting to tell my six year old, “Going forward…,” and was just glad I’ve always drawn the line at “ideation” (never could get comfortable with that one).
In the case of medicine, though, I wonder if there’s another reason why business-speak is the subject of such consistent, adverse attention: not because the language is hollow, but precisely because it isn’t.
Hear me out.
Doctors like to live in a world defined by care of the patient, of doing the right thing, of making a difference in people’s lives. These smart, sensitive souls chose – chose, for it was their choice — to be doctors, for goodness sake, not investment bankers or corporate flacks.
I get it – and more than that, I believe there truly is something incredibly special about being a doctor and taking care of patients; this conviction has been at the core of most everything I’ve written over the last twenty years.
But there’s something else: healthcare is a business – a huge business, nearly 20% of America’s GDP – and doctors, it turns out, like getting paid. I think many have an incredibly difficult time squaring a profession that feels like a higher calling with a very concrete need to pay the bills. (Arguably, society struggles as well with this dilemma between “doctor as calling” and “doctor as occupation.”)
Institutionally, you might argue, at lot of the dirty work has been done by EMR systems. Most individual doctors hate their EMR, yet these systems have been the perfect scapegoat for medical centers, on the one hand, enforcing a system that is laser-focused on maximizing revenue for the hospital that installs it, yet at the same time, permits doctors and hospitals to say, “it’s not us – it’s our EMR.” This is especially true in the area of interoperability, where of course (as health economist Jason Shafrin noted) hospitals are competitive, and don’t want to make it easy for patients (and their information) to “escape.” EMRs offer the ideal way for hospitals to achieve this stickiness while maintaining a modicum of plausible deniability.
I suspect at least some of the discomfort around the language of business in medicine relates to this same dialectic.
On the one hand, at a very deep level, most doctors feel they didn’t become physicians to chase the money, or to behave, or to talk, like a business person. Most deeply resent the conspicuous intrusion of business, and business concepts, into their lives and work.
At the same time, as physician and former-McKinsey consultant Bob Kocher pointed out on a recent Tech Tonics podcast, physicians are incredibly sensitive – and responsive — to market incentives. Presumably, this isn’t shocking news to anyone who’s watched med students compete for derm and ortho residency slots.
Very few physicians (or journalists) I know have been able to come to terms with the co-existence of both these aspects of medicine, and insist that medicine must be either/or; in the language of medicine, they believe your true intention should declare itself. Hence, the two popular archetypes: the doctor as saint, who cares only about patients, or the doctor as sinner, who cares only about profit.
The reality is that most doctors pursue both, though are more conscious of (and proud of) their efforts to care for patients, and often seem to repress (except perhaps when talking to potential industry benefactors) their entirely understandable interest in pursuing a stable source of income.
In this context, business-speak may, like EMR systems, serve a constant, unpleasant reminder of an aspect of medicine physicians righteously deplore, yet which is also responsible for ensuring the relatively robust salaries many continue to take home.
It’s not business but psychology that seems to have the right word for this: cognitive dissonance. It seems like a term and a concept that, going forward, more physicians would do well to recognize and acknowledge.
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