eMJA: Nair, Patient, client or customer?

Consumers & Healthcare

Patient, client or customer?

"There is nothing in a name, provided there is care" (hospital outpatient)

Medicare cards
Balakrishnan R Nair

MJA 1998; 169: 593

Introduction - Survey - Acknowledgements - References - Authors' details
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Patient: One who is under medical treatment;¹ or person who undergoes, suffers or endures a problem with respect to which health professionals can provide preventative, curative, comforting, caring and diagnostic interventions² (derived from the Latin pati, "to suffer"³).
Client: One who is under the protection or patronage of another or one who employs the services of a legal adviser.¹
Customer: One who customarily purchases anywhere.¹

The term "patient" has been used for centuries. However, over the past decade many allied health professionals have advocated replacing it with the terms "client"⁴ or "customer". Perhaps this is to demedicalise the issues of care or to avoid notions of dependence.⁵ In this era of political correctness which term should we use, and why? Acting on the advice "If in doubt, ask",⁶ we surveyed people attending outpatient departments of a university teaching hospital. Our method and results are shown in the Box.

We found that people in a healthcare setting prefer to be called "patients", rather than "clients" or "customers". One might argue that, as the survey was done in a hospital, these represent the views of the "sick". However, about 40% of the subjects were accompanying patients to the clinics, and were presumably "healthy". Previous studies of visitors to a hospital open-day found similarly that 87% preferred to be called "patients".⁷ Nevertheless, our study results may not be generalisable to inpatients or to people who are chronically disabled or disabled and well.

The patient-doctor relationship has evolved over the centuries and now consists of a partnership built on mutual trust, openness and respect. Despite this change, I believe there is no need to throw out the word "patient" -- it is better to accept the shift in its meaning.⁸ By calling people patients, I believe we are not making them sicker or denying their rights, as has been argued.⁹ "The unfortunate trend to stereotype honourable patients as obsequious clients and conscientious doctors as scheming entrepreneurs" should be resisted.¹⁰

Until we have stronger or better reasons to change the term "patient", it should be continued. Likewise, I prefer to be called "doctor" rather than "provider", "teacher", "clinician" or "adviser", even though my role might vary from patient to patient.

Survey on preferred form of address

Setting: John Hunter Hospital, Newcastle, NSW, on three consecutive weekdays in September-October, 1997.

Questionnaire: This began "Dear Sir/Madam" and stated "there are recent discussions about the term we use in hospitals, for people we are dealing with". Subjects were asked their preference from "a client, patient or any other title" and for their comments. To avoid selection bias for the first option, questionnaires with "patient" first and "client" first were alternated.

Subjects: 308 patients and their companions attending outpatient departments between 9 am and 3.30 pm were approached. All but one completed the questionnaire. Respondents were attending the following departments: radiology (51), accident and emergency (56), pathology (21), medical (45), surgical (40), obstetrics and gynaecology, including the antenatal clinic (54), paediatrics (25) and allied health (15). About 40% were companions. Almost two-thirds of respondents (199) were female. Age distributions for females were: under 20 years, 9%; 21-40 years, 45%; 41-60 years, 27%; and over 60 years, 20%. Corresponding figures for males were 6%, 35%, 29%, and 33%. Results: "Patient" was nominated as the preferred term by 85% of women and 83% of men (Figure, below). "Client", "first name" and "other" were each nominated by about 5%, while "customer" was nominated by only one person. The percentage preferring "patient" varied little between age groups, from 83% among those aged 21-40 years to 90% among the those aged over 60 years.

Comments by respondents included:
"'Client' implies business, 'patient' affirms the service nature of hospitals";
"It is not a business";
"'Client' sounds too commercialised";
"Because your hospital is not a solicitor's office";
"Any heading said politely";
"Politeness is more important than political correctness";
"Personal recognition is preferred";
"I feel 'patient' is sufficient to cover all";
"Always been called it. No need to change"; and
"There is nothing in a name, provided there is care".

Figure - pie charts

Acknowledgement

Thanks to Jeanne Ford and Lorraine Mayo for doing the survey, and to Dr Lynnette Lim for statistical advice. Thanks are also due to our patients, customers, clients and others for participating.

References

Onions CT, editor. Shorter Oxford English Dictionary on Historical Principles. 3rd edition. Oxford: Oxford University Press, 1968.
Englehardt HT, editor. Foundations of bioethics. Oxford: Oxford University Press, 1996.
Keks NA. Are patients clients or people? [letter]. Med J Aust 1991; 154: 432.
Herzberg SR. Client or patient: which term is more appropriate for use in occupational therapy. Am J Occup Ther 1990; 44: 561-564.
Raphael B, Emmerson B. Are patients clients or people? Med J Aust 1991; 154: 183-184.
Wing PC. Patient or client? If in doubt ask. Can Med Assoc J 1997; 157: 287-289.
Elliot J, White H. Patients are patients [letter]. N Z Med J 1990; 103: 593.
Doumani SJ. Should people visiting a doctor be called "patients"? Aust Med 1997; 9: 10-11.
Carter M. Healthcare partnership should be reflected. Aust Med 1997; 9: 10-11.
George CRP. Patients and clients [letter]. Med J Aust 1988; 149: 568.

Authors' details

Department of Geriatric Medicine, John Hunter Hospital, Newcastle, NSW.
Balakrishnan R Nair, FRACP, Associate Professor.

Reprints will not be available from the author.
Correspondence: Associate Professor B R Nair, Department of Geriatric Medicine, John Hunter Hospital, Locked Bag No 1, Hunter Region Mail Centre, NSW 2310.
Email: mdbnATcc.newcastle.edu.au

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