“Clients”: an Offensive, Dehumanizing Term in Health Care

Over the past 15 years, one of the most troubling trends in health care, has been the desire by health care bureaucrats, to start using the term “clients” instead of patients when referring to people who are in need of health care.

Proponents of the term (mostly administrators and managers who probably have never actually provided front line care) make all sorts of pompous, highly exaggerated claims about what will happen if we all start saying “clients.” Magically, people will feel empowered, autonomy will be promoted, and self-determination will suddenly be granted in the treatment planning and recovery process.

Not only that but social, physical, cultural, spiritual, environmental, medical and psychological needs will suddenly be taken care of in health care, because of course, doctors and nurses completely ignore all of this right now.

Reading through documents that promote the use of the term client is like reading a thesaurus of health care buzz phrases. “Shared decision making.” “Partnerships.””Declaration of Values.””Achievement of targets set out in the quality improvement plan.””Patient Experience.” (I note the irony in the fact that they didn’t use the term client experience). All this and much more, thrown randomly and in rapid fire succession at the poor reader, futilely hoping that something will resonate.

What poppycock.

Here’s the thing. The term patient has been around for hundreds (if not thousands) of years. While the bland dictionary definition is “a person who is under medical care or treatment”, the reality is the word has its origins thousands of years ago in Latin (patiens). It has a deep meaning dating back to the days of Hippocrates and denotes a special and honourable bond between doctors and nurses, and those that they serve.

Note my last sentence. “…those that they serve.” The word patient by its historical meaning clearly denotes a deep obligation on those of us who provide health care. The word patient compels us to heed our patients needs, their wants and their desires. It is we who serve them, not the other way around.

Does this always happen? Of course not. There are cases of doctors (and nurses) who have abused the privilege we have of looking after patients. These situations are offensive and diminish the rest of us, and are rightfully and appropriately dealt with by the regulatory bodies.

But here’s the thing. Using the phrase client won’t change any of that. Client is defined as “a customer, anyone under the patronage of another; a dependent.” Client, in its literal definition, suggests a hierarchical, dare I say even patriarchal, relationship that bureaucrats claim to oppose.

Why then is there a persistent desire to try and force this phrase on physicians and nurses? My two Canadian cents (2.44 cents American) is that this is likely driven unconsciously by the fact that many bureaucrats are jealous of the relationships doctors and nurses have with their patients. They won’t admit it, heck, they are probably unaware of it, but my strong suspicion is that the relationship we have with our patients is something bureaucrats fear.

One thing I’ve come to appreciate about bureaucracy in general is that it doesn’t actually care as much about cost savings, efficiency, or even patient experience. What matters most is predictability and control. Doesn’t matter if the budget is going to be three times more than last year, so long as bureaucrats know in advance that it will be that. Doesn’t matter if hospitalization rates go up, so long as, you guessed it, bureaucrats know about it ahead of time.

The reality of health care in Canada is physicians threaten predictability and control. Supposing a patient is admitted to hospital with a pneumonia. Some consultant from Dogbert Inc. will tell me that based on age and co-morbidities that person should spend 3.4 days in hospital. But what if that person lives alone? What if home care is stretched and can’t provide a daily visit on discharge? Well, then the physician will of course, keep the patient in hospital for an extra day or two (because we serve the patients). But there goes the plan the bureaucrat had put forth for the patient. The carefully laid out discharge prediction now has to be unexpectedly revised. The horror!

This is where the term client becomes really offensive, dehumanizing and degrading. When one has a client, they are essentially a commodity. Extraneous factors (likely living alone with no family support) have no meaning. They become a widget that actually has to meet uniform standards (out of hospital in 3.4 days!) or else.

This is why it offends me so when I see health care agencies use this term. Public Health units use it a lot, mental health services are using it and even the last referral form I filled out for Hospital for Sick Children used that phrase.

Shame on all of them.

Words matter. Patient is an honourable phrase, steeped in history and tradition. While ongoing emphasis and education needs to be placed on a patient’s right to autonomy and input into their care needs, renouncing a principled title like patient for a consumerist phrase like client is not the answer. We do need to do better to recognize patients rights, but we need to do it by better realizing the distinguished meaning of the word patient, and not by cowardly giving into bureaucrats who subconsciously want to diminish and degrade the sacred bond we have with those we care for.

And if you don’t believe that other front line physicians feel the same way, see the spontaneous applause I got when broaching this during my inauguration speech two years ago:

A 12 second snippet from my inaugural address, where there was spontaneous applause from physicians. A message for those in health care. Words matter. They are PATIENTS, not clients. #ONhealth #CDNhealth pic.twitter.com/gcsdkYh0AX

— Sohail Gandhi (@drmsgandhi) May 15, 2019