Is ‘patient’ a dirty word?

17 October 2018

Clare Bostock is a Geriatrician in Aberdeen. She has a keen interest in falls, triathlon and creative writing - but not at the same time. She tweets @ClareVBostock

I believe that we, people working with older people, are the forerunners in person-centred care. In fact, one of the main reasons that I love my job is the ability to tailor treatment to an individual’s wishes and goals.  So in this age of person-centredness, I’d like to ask you: Is ‘patient’ a dirty word?

Every time I enter the ward, I am greeted by a poster of a well-looking middle-aged man with the slogan: “Please don’t call me a dementia sufferer.”  I would never call him a “dementia sufferer” nor would I ever use the term “demented”.  The question is, when I am looking after such a man, should I use the term ‘person’ or ‘patient’? 

Children are often good at answering these questions, so I asked them.  My eight year old answered quickly: “You should use the word ‘patient’ otherwise it’s confusing.”  She is right. Margaret McCartney wrote a recent column in the BMJ: “Should doctors go to patients’ funerals?”  If the questions was, “Should doctors go to people’s funerals?” then there would be little debate.  My ten year old thought that ‘person’ was the best choice, after reminding me that I have been urging her to talk about “children who take the bus” rather than “bus-children” as they seem to be non-affectionately known in the playground. 

In my role as a committee-member reviewing conference programmes, I often suggest rewording a lecture title e.g. ‘people with diabetes’ rather than ‘patient with diabetes’ or worse still ‘diabetic’.  Many people living with diabetes or dementia would not view themselves as patients and would only be a patient for a small proportion of their lives.  However, I have been met with the response: “When did patient become a dirty word?”  If it were a dirty word, then surely The Patients Association would have changed its name? However, the word 'patient' does come from the Latin ‘to suffer’.

During my first house-officer job, I vividly remember a patient (ahem, person-receiving-healthcare) bursting into tears on the ward round and saying to the consultant, “You don’t even like me!”  To which the consultant arrogantly replied, “I don’t like you or dislike you.  You are a patient, and I am the doctor!”  Fortunately, things have changed - there are many initiatives focused on person-centred care such as What Matters to Me and Getting to Know Me.  In a recent BMJ summary of updated NICE guidance on dementia, the word ‘patient’ did not appear once - instead the article referred to ‘people living with dementia.’

Context is important, but we must never forget the person in front of us.  At team meetings, I squirm a little when a consultant colleague says about someone: “He’s mine.” The consultant may simply be affirming responsibility, however inside I think: “He is certainly not yours.” This man we are privileged to look after is a husband and father.  He has a profession, hobbies, fears and expectations.  We only know about the person if we ask, and we can be reminded that we are looking after real people by the language we use.  So what do you think?  Is ‘patient’ a dirty word? Or, do I need a little more patience before we lose the term ‘patients’?

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