When he or she is a patient apparently. Have we really not moved on from this false distinction? The discussion is an old one and I am still astonished by the resistance to the consumer movement which has after all been with us for 50 years. Consumers do of course come in different guises and pre-occupations which do depend on context – I started in detergents marketing where consumer she (and it always was ‘she’) was patronised by bright young brand managers – now ancient dodderers no doubt sat in front of their box set of Mad Men dribbling over Don and his ladies and those blurry memories of ‘lunch with the agency’. Back then tho’ they were the creators of the one way TV ad dialogue that told her that she was a super mum for choosing Persil while being asked really important questions like which colour of speckle she liked in her bath cleaner? Other versions abound – whereby the consumer becomes commodity – remember ‘self-loading freight’ for airline passengers? But that was back then – surely the idea of the consumer has matured into an idea that can be applied and used whatever the context of consumption and is not just a means of selling the profitable and new to the ?undeservedly affluent? It has after all been a while since the moment when people with money in their pocket escaped the smothering attentions of those who knew better and doled out the rations. A few bought Which? – most did not but survived nonetheless.
What seems to create problems is the fusing of the consumer with the more vulgar act of consumption – somehow always associated with too many sweeties thoughtlessly chosen and unthinkingly devoured in quantities that disgust their betters who set some store by their teeth and their waist line, thank you. Consumption is bad and consumers by association are tarred with the sins of greed and insatiability. This is an ingredient of the game that superior people play – the ‘I know better’ game. We used to play it in the brand office – a very lowly platform compared to the height of the pedestal built for professional folk – doctors, lawyers, civil servants – add your own. And of course the brand manager did know better in one sense – you knew why the speckle was there and what it was (well ..roughly -after all we brand office people were Arts men – the dreary old scientists did their test tube thing down at the factory – we assumed they knew what they were doing).
So when Alex Mold writes in the Lancet that ‘few aspects of the doctor-patient relationship in the UK are as contentious as the idea that patients are consumers’ this is the game that is being played. What is contentious exactly? The sheer cheek of it with patients half-informed by their Google searches demanding the ‘wrong thing’?
Collective provision vs individual choice
Alex identifies the important general issue of the collective versus the individual. The exercise of choice by an individual risks or so it is alleged others doing without. This of course is a way of adding yet more perjoratives – ‘selfish’ and ‘greedy’ – to the already vulgar consumer. The preferred alternative to this seedy figure is the citizen – stalwart, bright-eyed and bushy tailed, focused on the common good, mind and life uncluttered by delights of the piled shopping trolley and unmoved by the tawdry images of the Bisto mum. The citizen is ready to acquiesce and agree that their elected representatives along with with the producer/providers can be left to get on and divide up the communal pie and utter such consolations as come to mind if the pie is too meagre and the slices too thin. And of course the provision of service to the citizen is an ambition which is well-distanced from privatisation since the delivery channel remains the State.
The assertion that consumers and consumption are associated with the satisfaction of individual needs at the expense of others is at the heart of the contentiousness – it is the neoliberal conspiracy leading to the false heaven of private enterprise distorting our destiny with its tawdry temptations to spend our money where we like and on whatever we like. Prof Robert Tombs in the book I am insisting that all read – the English and Their History – points out that the argument is a religious one and since for him English politics still represents an old religious divide (read the book), these ancient and deep-seated differences gives this particular argument its edge. We are divided into saints – citizens – and sinners – consumers. This is about the powerful claiming ownership of righteousness. Consumers challenge that monopoly – and the only places where such challenges can still be safely and successfully resisted are the old State monopolies. Contentious – not just a word or a label but about the realities of status and control.