Euphemism in the language of managed care

Ostensibly, the subject matter of managed care (and of corporate medicine) is business exigency such as cost containment. Through the qualitative, linguistic study of the culture of biomedicine via participation in it as a clinical teacher, the author argues that the subject of managed care and downsizing is the fantasized magical conquest of death through the idiom of healthcare economics. The bottom line is not about the [economic] bottom line, but about dread, loss, hatred, greed, a world of dire scarcity, a world felt to be out of control. The scope of the terms manage, to manage, and management is explored. Furthermore, the attitude toward human relationship and to the world that characterizes the language of managed care, can be found for beyond the borders of American biomedicine. Euphemism plays a central role in translating destructiveness into banality, of masking motivations, resulting in the degradation of the physician-patient relationship, of health care, and of the personal intimacy that has long been at least an ideal of the physician role. Greater self-consciousness and self-criticism of the words and phrases we use in health care will help all practitioners and teachers to understand, emotionally as well as intellectually, the deeper meanings, wishes, feelings, and conflicts behind managed care--and which will no doubt be behind the clinical ideologies that are sure to follow when the managed care era passes.