Scholarly discussion has recently been directed toward the negative effects of consumerism in pharmacy education. Frequently in these discussions, the metaphor of student-as-customer is cited as an indicator of such consumer mentality. However, the customer metaphor is more deeply entangled in the thinking on this matter than has been acknowledged, even for those who roundly criticize its use. A richer understanding of the power of metaphor and of the fiducial obligations that underlie professionalism can help to create educational paradigms more likely to meet the best interests of students, faculty members, and the general public.Keywords: educational customers, consumerism, professionalism, metaphor, fiducial obligations Three thought-provoking essays published in the American Journal of Pharmaceutical Education focused on the deleterious effects of consumerism on pharmacy education. Cain et al convincingly argued that a student sense of entitlement can undermine professional education: "Grade inflation, student incivility, altered classroom practices, and decreased faculty member morale are all potential after effects of teaching students who hold academic entitlement beliefs."1 As a response, Karpen's letter offered a pharmacy student's refreshing perspective on what students legitimately expect from the educational establishment.2 Finally, Holdford's clever and insightful essay, "Is a pharmacy student the customer or the product?" warned of the threats to education posed by a related emerging trend, the identification of students as "customers" of the educational system.3 Although Holdford's diagnosis was insightful, his proposed cure was less so: he suggested the alternative to viewing students as customers was to view them as educational products we deliver to our real customers: the students' future employers and the public who would consume the students' services. While many of his observations were on target, this remedy would likely exacerbate rather than correct the problem, for it retained the consumer mentality that underlay the designation of student as customer in the first place. Nonetheless, this student-as-customer model is indeed a pressing issue because, in both education and medicine, a consumer mentality is increasingly threatening care. A more radical solution is needed-one requiring a better understanding of both the essence of professionalism and the uses and misuses of metaphor.Some may argue that it does not make a difference what we call students, 4 but this is not a pedantic quibble over terminology. Nomenclature sets up paradigms that govern our thinking, actions, and structures. To think of students (or patients) as customers is to think metaphorically: that is, to attribute to one entity the characteristics of another in order to provide clarity or insight.
5Metaphors are not merely rhetorical or poetic devices that do nothing more than clothe our preexisting ideas in fancy dress. They are extremely important organizational tools in the formation of our ideas and structure of ou...