Education and debateDo we need a new word for patients?Let's do away with “patients”Commentary: Leave well alone
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7200.1756 (Published 26 June 1999) Cite this as: BMJ 1999;318:1756All rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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”.
Competing interests: No competing interests
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 ?
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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."
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
Be patient, until you are not.
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.
Competing interests: No competing interests