The Lancet Student

Words Matter: Patients versus Clients

This blog was submitted by TLS Editor on 20th July 2012.
Tagged with patients, Clients, Communication

Max Koobatian

I don't normally talk or discuss topics that stray far from ethics, scientific research such as clinical studies or impactful medical breakthroughs. But I was speaking with a friend of mine who mentioned that in some cases doctors have been told to call their patients "clients" and how in some cases this has caught on. I feel such a topic deserves discussion. Words matter. This is why when we address others such as parents, colleagues, family or friends we avoid using words that may be interpreted as harsh, detached and unemotional. In a setting such as a hospital, how it is you speak to those that you are caring for must be done in the most professional manner possible. It can be argued that those admitted to a hospital are at their most vulnerable. Depending on their specialty and discipline, many doctors see people at their worst every single day (such as trauma surgeons and oncologists). When such doctors enter the hospital they have to stomach the fact that they may lose a patient, and that their family, friends, and loved ones will feel this loss. Others may be diagnosed with grim prognoses, while others are (I'm happy to say) given sighs of relief, and hope.  

If you have ever been given the opportunity to walk the halls of a hospital, or shadow a medical Dr. you'll routinely see medical doctors bonding with patients on an emotional and personal level that is absent from other professions. Not only do I find calling a patient a client out of touch, I also find that it is damaging and hurtful for both the medical doctor as well as whom he or she is caring for.

I feel that using the word client doesn't give justice to the service doctors and nurses carry out for their patients. Doctors are often seen as authoritative and decisive figures acting in their patient's best interest at times when making decisions can be stressful and in some cases impossible for their patients to make on their own. This is why we see a doctor as someone more than just a salesman. The word client implies a level of disconnect between the buyer and seller. For example when a salesman sells a car he is usually not bonding with whom he is selling a car to on an emotional and personal level. Instead the salesman's primary motive is profit and the bottom line. The salesman may even concede to his client’s demands if he or she wishes to purchase something that was not recommended to them. This is usually not the case in medicine because the patient rarely knows better than their doctor, so it would be unwise to choose a course of treatment that was not recommended to them. It is also common for a salesman to recommend buying a product that he or she won't buy for themselves or even recommend to their own family and friends. Furthermore a medical doctor is not in the business of selling and moving goods but rather caring for and looking out for his patient's best interests. This is not to say that in some cases businesses can do the same thing, and act in the best interest of their clients, but this dynamic and seriousness is quite different than tending to somebodies health.

I also feel that calling patients clients is a consequence to an unhealthy state of affairs that we live in (at least in the United States). There is extreme overlap between business and healthcare that we inevitably feel there is a price tag for everything; and psychologically when we purchase something we are automatically perceived as clients. This is understandable when in the United States a significant portion of income is often set aside just for healthcare; but again I feel that this is an unhealthy consequence of the times as opposed to addressing each other properly in a professional setting.

 In addition to the subtle psychological implication and tone there is while calling patients clients, if you implement an entirely consumer-based health care system and patients become clients against their will, the system itself falls apart. Paul Krugman writes that “To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most 'consumer-driven' health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.”

Paul Krugman also writes “The idea that all this can be reduced to money — that doctors are just 'providers' selling services to health care 'consumers' — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.”

My position is the same, and if we are ever forced by authority to call our patients clients, I feel that we should resist. The tone and connotation on the receiving end is cold and disconnected, and is a manipulation of language and perception. The result?  We end up reducing those that are in pain-and-suffering to nothing more than “clients” while simultaneously painting doctors as nothing more than “providers”.

http://www.nytimes.com/2011/04/22/opinion/22krugman.html?_r=1&ref=opinion