The Patient is MIA

The doctor will see the consumer now.  Next client please!  This ward is for customers only.  Sorry, we’re not taking any new persons with lived experience at the moment.   Call me old-fashioned, but whatever happened to the ‘patient’?

Why use the word ‘consumer’?  This term imports notions of consumer protection – the legal relationship between the receiver and provider of a service.  It carries an implication of minimum standards and avenues for redress if not satisfied with the service.  It reminds that you actually have rights.

And what about ‘client’?  This also highlights a relationship of service provider and recipient but it clothes it in a professional relationship, like a lawyer to a client.  It suggests a partnership built on mutual respect, and moves away from a paternalistic approach.

Are we all ‘customers’ now?  This paradigm points to a fee for service and imports notions of guarantees and minimum standards.  Like its cousin the consumer, it characterises the provision of medical treatment as a commercial relationship.

As for ‘persons with lived experience’ (PWLE).  Well, labels like ‘schizophrenic’ can carry negative connotations and can wrap an entire person into a single disease.  PWLE conveys the notion that it’s acquired and does not transform their identity.  It also reflects the ‘mental illness as journey’ concept.  It captures the subjective, personal and diverse dimensions of mental illness.  Qualitative research can inform health policy.

PWLE is beloved of government mental health bodies.  But I’ve also seen it used in political science literature to refer to first-hand accounts of living as a member of an oppressed group or minority.  Is that really the desired nuance here?

Which brings me to the now rarely sighted word ‘patient’.  This term locates the individual in a relationship.  It’s a dangler, meaningless without the other part of the equation: a treating doctor or institution.  For every ‘patient’ there’s a healer.  Isn’t that what it’s all about?  Aren’t we all after relief?

You could argue that these terms put sunlight on hidden aspects of health services.  That they put respect back on the table.  That they re-frame mental health in helpful ways.

True, but at a cost.

Eschewing ‘patient’ dilutes the historic notion of the physician as healer.  You’re not just buying a product or a service.  It’s more than a transaction.  There’s an ethical aspect as well – remember the Hippocratic Oath and the values articulated in its modern versions?  Highlighting the commercial side or consumer rights diminishes the ethical dimension.  And while PWLE’s focus on the individual might be empowering, that’s not always appropriate and anyway it reeks of euphemism – it too will eventually be felled by stigma.

Are these terms nuance, fashion or a little bit of PC?   Should we reclaim ‘patient’ or leave it as MIA?

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