In the New York Times, Paul Krugman writes, almost as an aside to his primary point on health care costs, about consumers of medical services.
How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.What has gone wrong with us?
Doctors don’t have consumers. They have patients. Lawyers don’t have consumers. We have clients. What has gone wrong with us?
This isn’t a mere rhetorical issue, but a reflection of the misguided change in the nature of our relationship with the people we serve, and how that relationship has changed from fiduciary to commercial. Consumers purchase services, and their importance to us is reduced to the fact that they pay us money in exchange for those services.
Clients, on the other hand, are people or entities who have entrusted themselves to our care, We hold their fortune and freedom in our hands, and have accepted the duty to care for it without regard to a direct cash quid pro quo. Once we accept the responsibility, their lives become our responsibility. They don’t pluck legal services off the shelf as if they were walking down a supermarket aisle.
Not long ago, I start reading the pitch from legal marketers about how their services would generate “leads,” potential customers who, with the right pitch, may purchase your services. Used car salesmen want leads. They have cars to sell and want anyone interested in buying a car, anyone with sufficient cash in hand, to come to their used car lot rather than the one across the street. Sellers want leads, and then it’s up to them to sell.
A couple of years ago, a brave (and foolish) legal marketer sent me an advance copy of his book, asking me what I thought. There was a chapter in there about generating “leads.” I told him I was offended by his characterizing clients as leads, that this was a marketing term and it fundamentally conflicted with what lawyers do. Lawyers do not seek “leads,” I told him. We seek clients. I thought it was outrageous.
But the use of the word “leads” has become pervasive in the legal marketing realm, and there has been no tsunami of lawyer outrage at marketers referring to clients as “leads.” It quickly dawned on me that I was the outlier, the lawyer who refused to see clients as mere consumers engaged in a commercial transaction. These were not people to be “sold,” but to be represented. These were not walking wallets, but human being in need of our professional help. But that was just me.
What has gone wrong with us?
By changing our mindset toward clients into seeing leads that we hope to convert into consumers, we’ve diminished the nature of our relationship with our clients. We now sell them however much justice they can afford, and are willing to buy. Would you like fries with that? Supersize? We try to milk the leads for as much as we can, getting them to purchase as much of our service as they’re willing to buy, whether they need it or not.
There is no aspect of our work more disingenuous than “unbundling,” a concept which we market as a benefit to consumers when in fact it’s just a marketing boon for lawyers. Instead of telling the client who either can’t, or won’t, pay for what he really needs that we cannot represent him, unbundling allows us to take whatever cash he’s got in his pocket and just limit our work, reduce our responsibility, cut our losses, while snatching up the small change the consumer is willing to spend. We know that clients need holistic advice and representation, yet pretend that if we draft the complaint, they can carry the water the rest of the way. It’s likely to prove disastrous, but we don’t care, as long as they’ve emptied their pockets and can’t blame us later for the mess they’re in.
It’s this quest for leads that has lead so many lawyers to create their own personal brand of porn, pitching consumers for the business by smiles and lies. All marketers lie, because without lies they would get no leads. Newer, better, shiner sells. If lawyers want leads, lawyers need to do the things that marketers tell us generates leads.
The business of law is no longer about our responsibility toward our client, but generating the next lead, bringing in the next consumer and getting the next fee. Once a lead is converted into a consumer and the sale is made, we move on to the next lead.
But we don’t sell used cars. We are responsible for people’s lives. We used to be, anyway. And people who are responsible for the lives of others don’t think of them as leads or consumers.
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Prolix, but right on. Nicely done. Sometimes Krugman is right; he’s one to watch. I like David Brooks better.
I can get a bit too wordy, but let he who is without fault cast the first stone.
SHG wrote: Lawyers don’t have consumers. We have clients. What has gone wrong with us?
I think the wrong turn can be traced back to the law schools. Law schools used to have students. Now they have consumers.
The business of law [schools] is no longer about . . .responsibility toward [students]. . . , but generating the next lead, bringing in the next consumer and getting the next fee. Once a lead is converted into a consumer and the sale is made, [the law schools] move on to the next lead
The parallels are definitely there, but is there a chicken and egg issue?
Yes, there is a chicken and egg issue. There is also an ocean of self deception- on both sides. It is time for law schools to drop the ivory tower model. Replace the Paper Chase with a new model- dental school perhaps.
How many college graduates would even consider going to law school if they thought it was like dental school.
Meh. You may have a good point, but Krugman doesn’t. “Consumer” is a term art. Economists calling a patient a “consumer” is like criminal lawyers calling a crime victim a “witness.” Krugman may legitimately have grown tired of the word, but he knows why everybody uses it.
I know I wouldn’t have gone. I hate the smell of a slow drill through enamel.
I don’t think Krugman was referring to the discussion solely between economists, but the broader discussion from politicians to insurers, all of whom talk about providers and consumers. Similarly, I don’t think the term of art that applies generically to consumers of goods and services applies the same to patients of physicians. People don’t go from office to office asking how much they charge for an appendectomy, and buying the cheapest one or perhaps ask whether they can get a discount on the operation if they do it without anesthesia.
The paradigm doesn’t fit professional services, and it shouldn’t.
Rumpole raises an interesting point:
“How many college grads would… if they thought it was like dental school?”
I’ve often wondered myself what draws people into certain professions and not others? Certainly not everyone’s motivations are pure. What about mortuary school? When was the last time you heard about the mortuary profession, a perfectly good, legal and lawful profession? What would draw someone there?
Certainly we need both autopsy specialists and mortuary workers–and dentists. But we don’t think of them in the same glamorous terms as we do “physicians” and “lawyers” whom our mothers and kindly neighbors somehow, for some ungodly reasons, put on the highest of pedestals.
There’s another way to read the title of this essay: “Take the Lead [OUT]”, as in the base metal we learned about in Chemistry class. Lead, the metal, being spelled the same but pronounced differently, a peculiar quirk of the English language.
It seems to me from reading these blawgs and essays about lawyer-marketing services of one sort or another that there are too many lawyers chasing too few clients. SHG and others has written about this. My point is: If the profession would “take the lead (rhymes with BED) out”, perhaps some natural balance could be achieved and you could go back to calling your new-found consumers “clients” again. No?!?
First, you’re on quite a roll today. Second, the old “learned profession” aspiration may well be reaching the point where it’s grown overipe and begun to rot. If so, mothers will stop pushing their babies to be doctors and lawyers, law schools will convert to mortuary academies and we will achieve Malthusian balance.
It will be painful, but good things often require some suffering.
Being that Krugman is a professional economist, and Brooks is a professional writer, I would reverse the sentence.
Remember the Dunning-Kruger effect: if you think you understand economics and you are not a professional, you are probably wrong. Brooks is often clever, and wrong simultaneously.
There is a strong parallel to the legal field here, if that’s not stating the obvious too obviously.
Even economists are allowed to be concerned with broader issues, though I’m not sure I would allow Brooks that same courtesy. Then again, one can never state the obvious too obviously.
It’s fairly clear that Krugman is trying to make a political point here, even to the detriment of the very area of study in which he received his NP. By sanctifying the doctor-patient relationship, its status is elevated above other economic transactions and thus the government should be in charge, everyone should get it for free, and it is beneath us to discuss it in terms of economics or worry about cost. It’s sacred, after all.
Of course, Krugman should be smart enough to know that even his sacred medical cow is not immune to the hard realities of scarcity and demand, which will happily toss his sentiments to the wind when push comes to shove.
You were doing so well until you got to the “thus” part about the government being in charge, which has nothing to do with his point about calling patients “consumers.” Filling in gaps in arguments with flights of fantasy aren’t generaly useful or persuasive.