The metaphor of patients as customers: implications for measuring satisfaction

The use of satisfaction surveys in health care reflects the current tendency to think metaphorically of patients as "customers." This article reflects critically on the logic underlying this metaphor because metaphors are integral to the meaning of concepts. We argue that because the metaphor works differently when considering satisfaction with the process of care and satisfaction with treatment outcome, there are theoretical reasons for assessing these concepts from different perspectives. It seems reasonable to ask patients to rate their satisfaction with the processes of care or services received (e.g., hospital food, the physical environment) in much the same way they would rate services received at a repair shop or restaurant. When evaluating satisfaction with treatment outcome, however, the customer metaphor is problematic because the body is made an object when it is conceived of as the repairable possession of a customer. We conclude that measures of satisfaction with treatment outcome should be based on the assumption that rather than having bodies, people are embodied. Hence, the validity of satisfaction with treatment outcome would be enhanced by questions about psychologic, social, and experiental aspects of treatment outcome.