UC San Diego

This dissertation addresses the widespread practice of calling the patient a consumer in contemporary discourses about health and medicine in the United States. Despite its common usage, little is known of the historical origins of this construct, how it entered popular discourse, and the symbolic and social significance of conceptualizing the patient as a consumer to current health care debates. Through historical research that spans the years 1930 to 2006, this study traces the patient-consumer metaphor to the patients' rights movement of the 1960s. Ideas about patient empowerment and rights emerged only after that decade's social and cultural transformations reduced the public's trust in traditionally authoritative and paternalistic institutions such as medicine. Calling the patient a consumer was a rhetorical tactic first popularized by the 1960s social movements involved in expanding patients' rights, including the consumer movement led by Ralph Nader. This periodization is supported by findings from a historical textual analysis of mainstream magazine articles on health and medicine from 1930 to 1969 that indicate the patient as an empowered health care consumer was not part of normative expectations of patienthood before the 1960s. Textual analysis of self-help literature, magazine and newspaper articles since the 1970s show how the patient- consumer metaphor's connotations of empowerment and personal autonomy in health decisions were co-opted and reduced to simple messages about consumer sovereignty by the 1980s as the US health care sector became increasingly corporatized under successive neoliberalist administrations. This dissertation's findings contributes to a more nuanced, historically based understanding of the ramifications of patient consumerism to better enable and support critiques of the American health care system