Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Doing away with "patients"
- Richard Thode (25 June 1999)
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Do we need a new word for patient ?
- David Abrahamson (28 June 1999)
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Health Care or Medical Care?
- Michael B Mayor (28 June 1999)
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A Solomon -like Approach
- William Bain (29 June 1999)
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Patients are for real
- Mike Thomas (29 June 1999)
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I'd rather be treated as a 'person'
- Tony O'Sullivan (30 June 1999)
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Re: I'd rather be treated as a 'person'
- Roger Stevens (1 July 1999)
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Aren't patients simply people?
- Matthew Rowett (1 July 1999)
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Users ???
- R Daniel Braun (4 July 1999)
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It's all in the Name
- David Kernick (5 July 1999)
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Whats in a name?
- Murat Acar (6 July 1999)
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Do other languages have better solutions?
- David Evan Morris (7 July 1999)
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"Patient" is bad; "customer" is worse
- Anne Peticolas (8 July 1999)
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Do we need a new word for patients?
- Olga Basso (12 July 1999)
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New words for old
- Nicholas Coni (12 July 1999)
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Be patient, until you are not.
- John R Birch (11 April 2007)
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Richard Thode, Project Officer, Oncology Education Committee Australian Cancer Society
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Dear Editor,
Part of Tallis' response to the Neuberger idea of doing away with "patients" (BMJ 1999; 318: 1756-8) is to suggest that if the debate is worth pursuing the next step would be to research what people actually think about the word "patient". While I'm certain that a small study down-under will not be the last word on this particular word, might I draw your attention to Nair's report last year in the Medical Journal of Australia (MJA 1998; 169;593)? "Patient, client or customer" studied 308 outpatients at John Hunter Hospital, Newcastle, NSW, and concluded that over 80 per cent of all patients approached, and over 90 per cent of those above 60 years of age, prefered the term "patient" over "client" or "customer". Full text of the report appears at: Might I also comment that the term "user" is rather more commonly used to refer to intrevenous drug users than health service users, and thus could lead to some interesting confusions over time, should it be adopted. Richard Thode (No competing interests) |
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David Abrahamson, Consultant Psychiatrist Mental Health Rehabilitation Team 313 Shrewsbury Road, London E7 8QU
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A fundamental objection to the term user must be that it devalues the personal relationships that are at the core of health services.To 'use' another person is in everyday speech to dehumanise and exploit them and is no more acceptable for patients vis-a-vis professionals than would be the reverse. More profoundly, in Buber's terms (1), it implies an I-It instead of an I-Thou relationship. Indiscriminate use of the term carer, rather than more specific alternatives such as parent, spouse, partner or companion, may have the same effect. Intriguingly, it is widely used by individuals and organisations that object to the term patient, despite the fact that in ordinary usage it more clearly implies a passive recipient in an unequal relationship. (1)Buber, M. (1937) I and Thou .Edinburgh: t. & T. Clark | |||
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Michael B Mayor, Professor of Surgery in Orthopaedics Dartmouth Hitchcock Med.Ctr., USA
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I am heartily in agreement with Professor Tallis' exposition, and resist abandoning the term "patient". I am profoundly distressed with the passivity of the medical professional establishment in supinely accepting our designation as "health care provider", in place of our prior identification as medical professionals. I would favor marshalling our resources and energies to reverse this perversion, to prevent something like what has occurred as governments have adopted the term "Department of Defense" for what was more properly known earlier as the "War Deparment". We might more accurately know whence our resources are pouring, in either theatre. |
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William Bain, Vice President, Corporate Affairs MDS Inc. Toronto
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In 1993, when I was Chief Executive of Royal Brompton Hospital in London we had a healthy internal debate about what name we should use for those who came to the hospital when we became an NHS trust in the Internal maket. The decision: call them patients, but treat them like customers. Incidentally, here in Toronto where I am now a Governor of a Hospital Board "client" is the term which hospital staff, including medical, have adopted |
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Mike Thomas
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Editor The suggestion that the term 'patient' could be outdated or even offensive(1) is indicative of the alienation that we as a society are currently experiencing from the realities of the human condition. To be human is to be subject to old age, sickness and death; this truth is often ignored or swept under the carpet in our current sanitized and homogenized culture, until it forces it's reality onto the individual, as sooner or later it will inevitably do. We find the reality of sickness and suffering hard to accept, and withdraw from the thought that there will come a time when we will be sick and in need of the help and support of a doctor. We find it hard to accept that we will one day need to enter into a doctor-patient relationship, and so downgrade medicine to simple information transactions. The term 'patient' is intimately related to that of a doctor, and the one implies the other as the two poles of the doctor-patient relationship. This relationship is a reality that continues to exist today, as it has always existed, in all human societies from the mists of antiquity to the modern day. Unlike terms such as 'health service user' or 'client', which reflect linguistic or political changes occurring in our society at a particular moment in time, the terms doctor and patient are universal and refer to deep and fundamental realities that are understood in all cultures and societies and relate to very real human experiences in the areas of sickness, death, weakness, vulnerability and trust. Although we in the medical profession are now involved in considerable health promotional activity and in sharing information with our patients to allow them to make their own decisions about their health, at the end of the day the core of our work remains the treatment of disease and the alleviation of suffering in our patients. In this situation the doctor-patient relationship remains of crucial importance, and the skilled doctor is able to use it creatively to help the patient. This process involves but goes beyond communication skills, personal and professional knowledge and technical abilities. The therapeutic use of the doctor-patient relationship is a skill that good doctors learn from time and experience. Patients and colleagues recognize this quality in good doctors, but it is hard to define and very hard to quantify. We live in a time when we are obsessed with quantifying the quantifiable, and this can lead to undervaluing of the unquantifiable and the qualitative. Whatever term is used, the reality of the experience of being a patient is one that will come to all sooner or later. The experience of being a patient (rather than a client or a user of health care services) is one that I have found useful and instructive, and I am grateful to my own doctors for their professional skill and help. I am sure that the experience of being a patient has helped me to be a better doctor. In my opinion it would be a tragedy if we were to loose contact with this fundamental relationship. If we all end up as users and providers of health care rather than as patients and doctors, then we will all be impoverished, and sick and vulnerable people will be denied an important source of help and comfort. Yours sincerely Dr Mike Thomas General Practitioner The Surgery Minchinhampton Stroud Gloucestershire GL6 9JF 1 Neuberger J Let's do away with 'patients' BMJ 1999;318:1756-57 (26 June) |
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Tony O'Sullivan, Secretary, Irish Patients' Association 78 Seafield Court, Killiney, Co Dublin
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Sir, this argument tries to address the interface between patient and doctor, without much conviction. From the patient's perspective, the term is quite appropriate as it reflects the anxious wait for treatment that is often incompletely explained by an impatient and harrassed professional. In Ireland, we have assumed a partnership approach to consumerism rather than a confrontational one, because we prefer to enhance trust rather than damage it. Nevertheless, we would go further in suggesting other alternatives to the term 'patient'. How about owner, employer, or manager? Ultimately it is patients who pay, whether directly in private care, or indirectly for public services. The latter suggestion, manager, reflects our belief that patients wish and deserve greater involvement in planning and development. This involvement is still in its infancy in the NHS, and merely a twinkle in our eye in Ireland. Our experience in supporting many patients traumatised by healthcare, is that they wish to be treated as people, and that is our suggestion. From now on, the patient will become a 'person'. Now there is a term that really has something to offer. |
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Roger Stevens, Partner Roborough Surgery
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Dear Sir, We need a word to replace 'patient'. Obviously becoming modesty forbids Ms. Neuberger from making the suggestion that henceforth patients should be known as 'Neubergers'. 'Neubergers' thus eponymously described should be on the same footing as past heroes of the medical profession, such as Parkinson, Addison and of course the far seeing Argyll-Robertson. I am sure this would facilitate the interactive Neuberger centred health promoting consultations which will characterise the Millenium. The word is Euro-friendly, refreshingly free from any taint of political incorrectness and does not have the emotive associations of its predecessor. In these days of lifestyle option consultations, when my receptionist tells me I have a surgery full of 'Neubergers' awaiting me, I shall know exactly what to expect! Should this idea fail to gain acceptance, with some trepidation I offer the term 'Bevanites', although I can't see this going down too well in the stockbroker belt! Yours faithfully, Roger Stevens |
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Matthew Rowett, Medical student Liverpool University
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In the current atmosphere of, (quite rightly), not wishing to objectify and label patients I am surprised to find that there is discussion on what is effectively how we can objectify and label them in a different way! Any label applied to a patient will have many of the disadvantages of the word patient and would simply be shifting the problem, (assuming there is one), around. We are taught to see the person behind the problem and the patient as a person. Therefore may I suggest that we actually start doing this and calling a patient a person, rather than labelling them as clients, consumers or anything else. I'm sure we can all agree that patients, whatever their circumstances, are most definately people. |
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R Daniel Braun, Clinical Professor Indiana U School of Medicine
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The term "User" has a totally different connotation in the United States. It means a "User" of illegal drugs. In other words, it is a slang term for drug addict. So, even if it should catch on in the U.K., I seriously doubt that it would be used(pardon the pun) in the U.S. The biggest push for change in the U.S. seems to come from nurses and physician extenders who want to and do use the word "Client". THis has lead to many discussions between physicians and physician extenders. Most physicians take the attitude that "Lawyers have Clients." |
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David Kernick, General Practitioner St Thomas Health Centre, Exeter
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St Thomas Medical Group Research Unit Cowick Street, Exeter EX4 1HJ A Research Practice sponsored by the NHS South West Regional Health Authority Research and Development Directorate 05 July 1999 The Editor BMJ BMA House Tavistock Square LONDON WC1H 9JR Dear Sir It's all in the Name (Letter for Publication) A recent debate on what to call the object at the blunt end of the stethoscope (Do we need a new word for patients? Neuberger J, Tallis R. BMJ 1999;318:1756-1758) had more profound implications than the "regressive, reference-less data-free airing of opinion" that Tallis suggested. The Lexicon both reflects and shapes the way that we construct the world around us and Tallis demonstrated clearly his entrapment within a modern, linear medical paradigm. Neuberger struggled unsuccessfully overlooking the importance of the evolving context. In the beginning, the patient was clearly defined as the one that shut up and did as he or she was told by the doctor. The late 70s saw the evolution of a more tenuous relationship between health and health care; patient becomes client. In the early 80s, evidence based medicine begins to call the shots and health care manipulates the odds against a background of inferential statistics; client becomes punter. The late 80s see a shift of emphasis to economics with the purchaser-provider split reflecting the directives of the market; punter becomes consumer. In the late 90s, there is an evolving perspective of co-operation with an emphasis on partnership in health; consumer becomes citizen. But where for the next millennium? Complexity theory is beginning to unravel a picture that sees doctors and citizens as players tentatively performing their roles on a complex non- linear stage. Perhaps Shakespeare and Health Economists were right all along. Both patients and doctors should be known as Actors (1). Yours faithfully Dr David Kernick (1) The name's the game. Kernick DP. Lancet 1999;353:1632 |
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Murat Acar, Rehabilitation Medicine Trainee Westmead Hospital Sydney AUSTRALIA
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Sir, To imply that the title "patient" is a derogatory connotation is a gross oversimplification again borne out of the farcical of political correctness! Whoever invented this silly debate has the onus on themselves to find a better name so we can get on with our real jobs which undisputedly should be to "cure sometimes, heal often and comfort always". Seriously, if there is a doubt as to the relationship between medical doctor and patient this is not because of a misinterpretation of the title "patient"; rather there should be a properly focused re-analysis of our role as medical professionals, based on the guidance of the "consumers" of that care. Perhaps in this modern era of litigation happy "patients" we should be changing titles from doctor/patient to defendant/plaintiff. Clearly the argument can get messy here! If we are to be promoting choices for patients, as "users or consumers", do we really want this; changing a title will not do this!. Beware the patient seeking out their versions of appropriate health care: who may be doctor shopping for antibiotics for an upper respiratory tract infection despite the previous doctors attempts at education to the contrary; also beware the patient who prefers the prescription happy "diazepam prescriber" in preference to the "sleep hygiene instructing doctor". Consumerism has its pitfalls too I'm afraid, but this is only too obvious. If we are to respect our patients as "people" clearly this is the responsibility and choice of the medical professional and any amount of force will not change this, least of which by changing the designation from "patient" to "person". Medical educators know too well that you cannot change the personality of a medical student into society's vision of the "ideal doctor". To imply that as doctors we do not recognise our patients as persons, nor the heterogeneity of the patients that request our assistance, is a non-sensical assertion which must be addressed well and truly before a change in the title of "patient" is due. Any replacement title for the word "patient" will no sooner have assumed its new designation before it too, in a meaningless battle, suffer the slings and arrows fought against its old rival. I have no competing interest/s. Murat Acar |
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David Evan Morris, General practitioner St Mark's Dee View Surgery, Connah's Quay, Flintshire CH5 4AD, Wales, UK
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Do other languages have better solutions? Our Welsh word for "patient" is "claf" (plural "cleifion"). Like the French "malade", it literally means "a sick person", or "one who is ill". As such, its historical origin is apparent, and, while it may not convey the passivity of "patient", yet it is imperfect for the well-person consultation. As a general practitioner, I have about two thousand registered patients ( that word again ! ); if I speak of them in Welsh as so many "cleifion", I certainly do not wish to mean I am responsible for 2,000 sick people at any one time ! Any improvement from other languages ? |
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Anne Peticolas, Senior Systems Programmer Department of Veterans' Affairs, USA
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This discussion leaves me with mixed feelings. The word “patient” is a horrible word, having every overtone (to me) of suffering, passivity, and powerlessness that Julia Neuberger suggests; I have always hated it. Still, it has one huge advantage: it is specific to the medical relationship. Bad though “patient” is, I loathe “customer” and “consumer” even more (I’m a computer professional, and management now wants us to call our users “customers”; I also dislike that). “Customer”/ “consumer” make the relationships primarily monetary, and though both physicians and computer professionals mostly sure do want to get paid (me too!), to make this the essence of the relationship is an awful distortion. There used to be a Boston guy who wrote books about personal computing who invited folks to call him at home day or night and provided free computer assistance; and doctors on occasion provide services for free. The essence of the relationship is still precisely the same as it is when the “service provider” is paid. I see nothing wrong with “user” except that it is not specific to medicine. It is active and dignified and brings to my mind computer users (including “power users”) not drug users (although one could reflect that almost all users of medical services are also (pharmaceutical) drug users). I serve my own users and consider myself a user of computer vendors’ software products and services and as such am very comfortable gathering with others to discuss technical issues in “user’s groups”. Perhaps “medusers” would capture the specific essence, but is too obviously a made-up word. A friend facetiously suggested “sickies” instead of “patients”. This is specific to the medical relationship, and captures my sense that despite what Ms. Neuberger (or the practitioner with 2000 patients on his list) says, any relationship between a physician and a healthy person is purely derivative from the essential relationship between doctor and sick person. But, “sickie” is not going to fly for this, though other languages may indeed use the equivalent for the concept and to me it would be better than “patient”. I would add that practically speaking, for me a lot of the curse is taken off the word “patient” when a physician addresses me by last name and title and I then feel much more relaxed in a medical situation; conversely, to address me by first name compounds the indignity of “patient”. |
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Olga Basso
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I have read with curiosity the considerations on whether to keep the word 'patient'. One contributor advocated the need to change this word, while the other was firmly against. The latter contributor thought that a 'referenceless' debate on the issue was a 'regression', and that the next logical step if this debate was to be continued was to investigate what do people think about the word and provide data... As one of the 'people', I am willing to offer my opinion, but I have no claims as to whether it should be used. I am an epidemiologist, but not a physician. My opinion on the word 'patient' is, I believe, quite unique, but I feel it is logically and linguistically sound. To me, the word 'patient' means 'ONE WHO ENDURES A DOCTOR (or other health professionals)'. The enduring part is clearly funded on the etimology of the word. WHAT the 'patient' is enduring is never actually specified, and in the common interpretation what is endured is a suffering, or any illness. To me, this does not hold true, because one can be ill, or hurt, and one remains simply ill or hurt as long as a doctor is not in the vicinity. As soon as a representative of the health professionals appears (or is sought) to acknowledge the problem, THEN, and only then, one becomes a PATIENT. 'Patients' do not exist if not in the presence of physicians, and to me that denotes clearly that what is being endured is actually the doctor... With this consideration in mind, I think physicians may be willing to change this word. I personally like it, in this interpretation... IF it is necessary to replace this word, however, we should really have a better alternative, and I do not think that either 'client' or 'user' will do. My considerations are purely linguistic. I hold no grudge against doctors, despite what it may look like. Best regards Olga Basso Danish Epidemiology Science Centre Vennelyst Boulevard 6 DK-8000 Aarhus C Denmark |
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Nicholas Coni
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Editor Neuberger is the latest in a long line of those who seek to change our language for doctrinaire reasons (1) The same issue of the BMJ carries a delightful review of what sounds an excellent book (2). The fourth sentence of the second paragraph, translated into p-c-speak, would read "Island doctors arranging for their users to get to the mainland provider unit by ferry...". I let professor Tallis' case rest (3). The old asylum was a place of safe refuge, so much needed by its residents. The word was consigned to history and was shortly followed by the institutions themselves. Even current jargon has its pitfalls - where there is a provider, there must be a recipient, and for every user, presumably a used. We should salute those few hospitals who stuck to their proper titles on their stationery. Who can feel intense loyalty to an NHS Trust? We should show the same resolve with our patients. Not only do our North American colleagues do so, as Tallis points out, but Hispanic physicians also retain their pacientes. Nicholas Coni Retired geriatrician Cambridge CB3 OHM 1 Neuberger J Let's do away with "patients". BMJ 1999;318:1756 - 1757 (26 June) 2 Britten N Doctors talking BMJ 1999;318:1770 3 Tallis R Leave well alone BMJ 1999;318:1757 -1758 |
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John R Birch, consultant Home Freedom Unlimited 22042
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Consistent with the professor's criteria for change, and the urgent need for change in all things that are imperfect, I propose we each use the principals of Homeopathy & Aikido. With each patient, use the growing difference between the etymology of the term, and our own maturing ideal of someone we care for, as a reminder and opportunity for education and exploration. In every unique relationship which comes from teamwork, we often overlook ways to optimize our own and our patient's individual issues of health care. Language changes as fast or slow as the complexities of culture permit. Lets change ourselves and our culture, focus on putting the lie to the mnemonic term 'patient patient'. Like a grain of sand in an oyster, this flaw, properly nursed & cultured can trigger growth in our profession and society to provide the best environment for our patient's health. At some point in the future, the perfect word will exist. We or our professional progeny will discover it, and be better able to accomplish our eternal mission. Competing interests: I am an occasional patient and a nursing engineer, making a living from the imperfection of others. And I like it. |
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