1. Brownson, Kenneth

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Is the term "patient" overused? Patient has been used for centuries to describe a person who receives care. The term is derived from the Latin pati, which means "to suffer" and "an individual awaiting or under medical care and treatment; the recipient of any of various personal services; one that is acted upon." Merriam-Webster Medical Dictionary defines patient as "a sick individual especially when awaiting or under the care and treatment of a physician or surgeon."


There is a developing trend toward using different terminologies in different settings, but thus far, there is no universal agreement in the health care industry. "Client" and "customer" have been used in an effort to alter the perception of the "health care professional-patient relationship" as a "power-dependency" relationship. Managed care has added "provider" and "consumer" to the list of terms to denote those providing services and the person who is receiving services.


Patients or clients are unsure of what they want to be called. One survey conducted at a medical hospital in Trinidad found that 80% of people preferred the term patient while 6% preferred client and 7% preferred customer. A survey at a pain clinic in Canada had similar results, with 74% preferring patient and 19% preferring client. A survey in an Australian hospital setting found that 84% preferred patient while only 5% preferred client. A survey conducted in the United States with people being treated at various inpatient and outpatient psychiatric programs had contrary results. Forty-five percent preferred to be called client, 20% preferred patient, and 8% preferred consumer. Apparently, what one is called depends on country and specific type of health service. Age is also a factor; the preference for the term patient increases with age.


Service providers are also unsure what term to use. Physicians strongly prefer patient. Other health care professionals convey mixed preferences. Younger professionals (under age 29) prefer patient, while those over 29 are more likely to use client, perhaps the opposite of what one would expect. Older professionals have more experience and are more readily influenced by the development of alternative perspectives and language choices. Female professionals prefer the word client more than men do, and client is preferred in the occupational therapy setting. The nursing profession appears to be adopting client as the more universal term.


The consumer movement has fueled the desire to replace patient with something that reflects the steady spread of consumer empowerment during the 1990s. We have been encouraged to take a more active role in our own health and become active partners in our care. This has removed the sense of total dependency that patient signifies. People who oppose being called patient consider the term to suggest sickness, disability, authoritarianism, and paternalism, and they find its use inappropriate in rehabilitation, illness prevention, and health maintenance contexts.


Many people find the use of patient appropriate for one who is hospitalized following a stroke in an acute care facility but not in a rehabilitation facility. Using patient to refer to a person who visits to a doctor's office for routine care or a dentist's office for cleaning or restorations seems inappropriate to many people. Drugstores frequently refer to people picking up their medications as patients as do some freestanding laboratories.


A person with a minor illness visits a physician's office for a routine physical or perhaps to get a flu shot. The receptionist tells the doctor, "Your 10 o'clock patient is in room 2." A person visits a physician's office for a flu shot administered by a nurse and the receptionist says to the nurse, "A patient is here for a flu shot." In going to a dentist's office for a filling or a routine cleaning, one is a person in the parking lot, but once in the dentist's office, one becomes a patient. The receptionist announces, "Your 10 o'clock patient is here."


Likewise, one who has a question to ask a pharmacist about a prescription, one who enters a freestanding laboratory service for routine blood work, or one who goes in for a routine eye examination becomes a patient immediately upon entering. Patients sometimes have their own designated parking spaces, so perhaps there are some benefits to being a patient ("Parking for Patients Only").


One of the most offensive uses of the term patient occurs in the context of an execution. When Timothy McVeigh was about to be executed, news media representatives were doing extensive coverage. They would often interview a physician to describe the effect of each phase of the lethal injection. In many instances, they would refer to prisoner McVeigh as "the patient." The literature makes similar associations between a prisoner being executed and a patient. Apparently, during an execution in Texas, the chemicals were too weak causing the "patient to choke and heave for several minutes before death came." In another article describing physician involvement in executions, it mentions that a physician may be called on for advice as to whether additional shocks or lethal chemicals should be administered or whether the "patient should be resuscitated to await a future execution attempt." A discussion of the State of Missouri's protocol for lethal injection describes the role of the prison physician to "pronounce the patient dead when he is dead and then to sign the death certificate."


People with chronic illness also suffer from overuse of the term patient. A person can have diabetes, emphysema, arthritis, or AIDS but still be working and completely independent in all aspects. They are forever known as a "patient with AIDS, diabetes, etc." in the media. They are never called a person who is doing something productive or a person with AIDS or diabetes.


Is the term "patient" overused? What is the alternative or should we use different terminology in different settings? Should patient be used only in the acute hospital setting or do we need an entirely new word? Perhaps it is about time for patient and even client to be phased into extinction while being replaced by new and more sensitive and descriptive terms.


Kenneth Brownson (New Castle, Del) is on the Editorial Board of The Health Care Manager.


This issue of The Health Care Manager (23:2, April-June 2004) offers the following articles for consideration:


* "Nursing Leadership: Serving Those Who Serve Others" encourages nursing management to promote consideration of a servant model of leadership as a means of securing and retaining caring nursing staff, recognizing that in a human service setting, such as health care, the servant-minded leader is often the most effective leader.


* "The Measurement of Performance in a Physical Therapy Program: An ROI Approach" describes a model intended to measure the performance of a physical therapy unit in terms of return on investment.


* "Work Status Congruence, Work Outcomes, and Psychologic Well-being" describes a study of working, hospital-based nurses, both full-time and part-time, to determine whether congruence of work status led to greater employee satisfaction and psychologic well-being.


* The Case in Health Care Management, "The Uncooperative Colleague," asks the reader to consider what to do when a manager's counterpart on the following shift is apparently not performing up to the requirements of the job.


* "Leaders Who Create Change and Those Who Manage It" suggests there are some significant differences between creating change and leading change and describes the differing leadership approaches best suited for each essential activity.


* "The Benefits of a Work-at-Home Program," as the title suggests, explores the advantages that can sometimes accrue from a telework or telecommuting employment arrangement.


* "Indicators of a Healthy and Sustainable Community: The Central Florida Experience" discusses the important role that health care organizations can play in developing and sustaining healthy communities and describes how this concept was applied in 7 counties in central Florida.


* "Applied Game Theory for the Hospital Manager: Three Case Studies" promotes the value of an understanding of game theory as a useful modeling strategy for predicting human interactions and the potential outcomes of certain decisions.


* "Hospitalists: Evolution, Evidence, and Eventualities" presents an in-depth literature review concerning the growth, development, and likely future directions of hospitalists, those physician who spend at least 25% of their time serving as physicians-of-record for hospital inpatients.


* "The Looming Crisis in Health Care: Fact or Myth?" reports on a survey of 400 randomly selected hospital human resource managers undertaken to assess the relative importance of numerous challenges impacting health care operations today and in the foreseeable future.


* "Strengthening Organizational Commitment" recognizes commitment among followers as one of the most significant challenges facing health care leadership today and explores possible means of strengthening commitment and developing practical employee retention strategies.


* "Interpersonal Skills: What They Are, How to Improve Them, and How to Apply Them" suggests that anyone's interpersonal skills can be improved through conscious effort but that the individual must first recognize the need for improvement; that is, recognize that there is always room for improvement in one-to-one communication and that too frequently we take interpersonal communications skills for granted.