The Destruction of Words

A colleague recently pointed me to a commentary in The American Journal of Medicine entitled “The Language Game: We Are Physicians, Not Providers.” I rushed to look up the article immediately, hoping to find corroboration for my distaste for the term “provider.” and anxious to read the words of kindred spirits who recognize the games people play with language.

The authors start out fine, rightly proclaiming that words do more than express our thoughts—they also conscript our thinking and, ultimately, shape our actions. The term “provider,” the authors continued, is not a neutral term of inclusivity. Using this term to describe physicians has important consequences. It falsely equates the contributions of all members of the healthcare team and transforms the patient-physician relationship into a commercial transaction.

So far, so good, but then the commentary takes a horrible turn. The authors proceed to link the term to the Nazis:

"And here is the irony of “providers.” The term was first introduced by the Nazis in the 1930s when trying to debase German physicians of Jewish descent. ... By 1938 the government simply revoked their licenses, so that instead of being called “Arzt” (ie, “doctors”) they were demoted to “Krankenbehandler,” that is, mere “practitioners” or “health care providers.” The term “Krankenbehandler” ultimately was applied to all German physicians of Jewish descent. … Soon after, mass deportations began. Words have societal implications."
Oh, my goodness. This may be the absolute worst example of Godwin’s Law ever published in a medical journal. The AJM should be ashamed.

For those unfamiliar with Godwin’s Law, it was coined by writer and attorney Mike Godwin in 1990, to describe “the widespread phenomenon of glibly comparing someone else to Hitler or Nazis to win an online argument.” It is a crude and lazy rhetorical device. Once you make the accusation of Nazism, there can be no further discourse on the merits of the argument. The discussion is over.

Linking the term “provider” to Nazism is not only crude and lazy, it is ahistorical. There is no direct connection between the German word “Krankenbehandler” and the English word “provider.”

The authors of the AJM commentary acknowledge that the use of the English word “provider” dates back only as far as the mid-1960s. Coincidentally, Congress passed the Medicare Act in 1965, and the legislative necessity of defining the entities to be paid under the new program likely gave birth to the term.

To this day, the Centers for Medicare and Medicaid Services define “provider” as “any organization, institution, or individual that provides health care services to Medicare beneficiaries.” There is nothing sinister about this definition. CMS wants us to get paid for taking care of patients. Physicians are not being “debased.” This is not a prelude to revoking our licenses. Medicare and Medicaid have had tremendous societal implications, but 57 years after their inception, we are no closer to “mass deportations.”

Linking the term “provider” to the Nazis is inappropriate—and like all inappropriate Nazi comparisons, it is highly offensive. As historian Edna Friedberg wrote for the United States Holocaust Memorial Museum:
It is all too easy to forget that there are many people still alive for whom the Holocaust is not “history,” but their life story and that of their families. These are not abstract tragedies on call to win an argument or an election. They carry the painful memories of the brutal murder of a cherished baby boy, the rape of a beloved sister, the parents arrested and never seen again.
It is disturbing to agree with the thrust of an argument while taking offense at the tactics used by the authors. Their Nazi references make me cringe, but the authors are correct to point out how language can be manipulated for political ends. I especially appreciate their reference to “Newspeak” in George Orwell’s Nineteen Eighty-Four.

The goal of Newspeak was the destruction of words—a project to narrow the range of thought and make it easier to equivocate and confuse the public. Orwell recognized how useful this tactic was to demagogs and authoritarians.

Healthcare, because it deals with complex and difficult ethical issues, is especially susceptible to demagoguery. Recall how the Affordable Care Act’s coverage for advance care planning was held up for years by calling it “death panels.”

Unfortunately, we continue to see these tactics used in healthcare debates:

  • Those who oppose sensible policies to combat the COVID-19 pandemic lump them all together under the term “lockdowns,” a simplistic and inaccurate term to negate reasonable discussion of risks and benefits.
  • Immunizations and vaccines have been relabeled as “mandates,” a term with strong negative connotations. Already, we see the public—which once overwhelmingly supported school-based vaccine requirements—expressing doubt and opposition.
  • Our nation’s centuries-long battle against systemic racism is now dismissed as “CRT,” a nebulous boogeyman to scream about at school board meetings.
  • Discrimination against LGBTQ persons in healthcare is being promoted as a “right of conscience.”
  • Legislation promoting quack treatments for COVID-19 is now called “medical freedom” laws.
Orwell, in his essay “Politics and the English Language,” stated:
Political language … is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind. One cannot change this all in a moment but one can at least change one’s own habits, and from time to time one can even, if one jeers loudly enough, send some worn-out and useless phrase … into the dustbin where it belongs.
This is how we stop the perversion of language. We simply refuse to accept the destruction of words. We must not allow our opponents to reframe the question by changing the lexicon of debate. We may not be able to jeer loudly enough on our own to make a difference, but we can be heard when we join our voices in collective action.

The AAFP is our collective voice, and it is a loud and effective voice. The use of the term “provider” seems to be on the wane, perhaps as a result of a formal declaration against the term adopted by the AAFP Congress of Delegates in 2018.

If you call me a “provider” I will correct you, cite the AAFP policy, and hope that this action has sent this term one step closer to the dustbin of history.

The one thing I will not do is call you a Nazi.

Mangione S, Mandell BF, Post SG. The Language Game: We Are Physicians, Not Providers. Am J Med. 2021 Dec;134(12):1444-1446.

Abby Ohlheiser, “The creator of Godwin’s Law explains why some Nazi comparisons don’t break his famous Internet rule,” The Washington Post, August 14, 2017.

Edna Friedberg, Ph.D., “Why Holocaust Analogies Are Dangerous,” United States Holocaust Memorial Museum, December 12, 2018.

Provider, Use of Term (Position Paper), American Academy of Family Physicians.

This article was published in South Carolina Family Physician.