Thursday, 24 April 2008

What's in a name?

"What's in a name? That which we call a rose
By any other word would smell as sweet"
- Billy Shakespeare

Frontier Psychiatrist asked, "Whether I should describe people who use psychiatric services as 'patients' or 'clients'/'service users'."

We asked in-patients, day hospital patients, out-patients, home visits and day respite patients what they wanted to be called. We then did it all again, months later. We then did it across the entire district. We then asked a carer forum. We then asked another carer foruim. We then asked the local Alzheimer's Society branch. Locally MIND isn't that active with older adults, but we asked them anyway. The response was almost 100%, we should address them as "patients."

To stop stigmatising mental illness with different terminology, to stop them being called "clients" (which resonates with hairdressers, prostitutes and lawyers) or "users" or "service users" which our older adults associated with drugs, "patients" it was.

Locally, if a pregnant woman is going to her antenatal check up, or a bloke is going to see a surgeon for a vasectomy, or a mum is going to have her diabetes sorted out, they're all referred to as patients and all attend an out-patient clinic. The woman is well, undergoing a normal life event. The man is well, seeking an elective operation for a common life choice (on contraception). The mum is currently well but has a life long propensity for becoming unwell if she stops her medication or has physiological stressors. All are referred to as patients.

Why, if you're well but experiencing a common life event but wonder if all's normal (e.g. memory problems with age, is it just age or is it dementia), or seeking elective management and interventions (e.g. help with substance misue) or seeking assistance in the management of a long term problem but you're currently well (like schizophrenia) should you be overtly named and labelled differently from the pregnant lady, the bloke seeking a vasectomy or the diabetic mum?

That's stigmatisation.

Isn't that wrong?


Anonymous said...

I'm delighted to read this - I've been trying to stick to the term "patients" for years. I think it reminds us that we have a duty of care; "clients" are those out of whom you aim to make a profit.

Jobbing Doctor said...

I so agree. My eldest daughter, who is training as a social worker uses the term 'service user' which I can just cope with; my middle daughter, who is a staff nurse, is like the jobbing doctor and uses the term 'patient.'

The use of the term 'client' is an underhand term to commercialise care: we know where that leads, don't we. Chaos and rubbish service.

Disillusioned said...

Totally agree. The term "service user" really grates on me. "Client" (as used byt he psychology service) is even worse. I'd much rather just be a patient. After all, I've been given plenty of opportunities to f practise being patient!

Fiona Marcella said...

I've said it before but I'll say it again - the only advantage to "service user" is if you're writing an essay and want to up the word count.

Cockroach Catcher said...

Most commercial companies have special incentive schemes for employees to dream up scams (sorry I was trying to type schemes) to get the most out of their clients.

Even in that organisation called NH Something, there are performance related bonuses that are client related.

Told you there is still standards in every organisation: patients can NOT be treated like clients.

I am sure you have all worked that one out.

Cockroach Catcher (still on vacation)

frontierpsychiatist said...

Thanks for the feedback!

I've been using patient up to now and the only thing I like about service user/client is that it feels to me that in using this term the person is not so obliged to enter into the sick role.

On an almost unrelated point, I went to a course last week where we were told that 'brainstorming' is considered to be a un-PC term these days and that we should use 'thought shower'. This is due to the feelings of epileptic patients. This really annoyed me for a reason I've yet to unpack. A quick visit to the relevant wikipedia page informs us that most people with epilepsy actually don't mind.

At the same meeting there was also a long discussion about the use of the word 'mad'.

It was a very long day.

The Shrink said...

"Thought shower" is terrible, as it "chalk board" instead of "blackboard"

As I often say, I'm not a politician and I'm oft times not correct. I therefore take great delight in ignoring all so called political correctness.

Anonymous said...

All this PC rubbish drives me mad! If I were to ever here a doctor refer to me as a "client" or as a "service user" I would probably give them an ear full about political correctness (read without "probably").

I remember my first day on a community placement in a primary school during my last year at Secondary School. I was advised (after using the terms to pupils) that "blackboard" and "whiteboard" might be construed as being racist and that I shouldn't use them anymore, but instead use "Chalkboard" and "pen Board". It wasn't that long ago since I was in primary school and we never thought twice about the possible racial connotations of "blackboard" and "whiteboard".

I heard stories from my friends who did placements in nursery schools about how they had changed the words to "Ba Ba Black Sheep" because it might be "racist"

One of my colleagues told me a story of how she and her husband were told their five year old was a racist got into trouble for calling a coloured child in his class a "stupid potato head". I'm still trying to work out the logic behind that one!

I attended an Equal Opportunities seminar at my Part-time job and had to try very hard and not laugh at all the PC rubbish that was coming out of the mouth of the manager taking the course. 99% of it was utter nonsense! Some of the things we're no longer meant to say because it's sexist, racist homophobic, ageist or something else along those lines.

Hospital Wallpaper said...

It wasn't until my psych rotation that I realised that many of the phrases we do use in every day life can be construed as offensive. Such as "I'm having such a manic day", "he's such a psycho" etc.

But surely this is about the evolution of language, how words that originally mean one thing can end up meaning something completely different in years to come.

I refuse to go down the service user/client route. Stinks of the stealth privatisation of the NHS to me. It simply doesn't work as a business model.

Unknown said...

I agree with most of this (def go for patient not service user) but also notice.. while on one hand most peeps claim 'PC gone mad' and use ridiculous examples that someone without a clear grasp on semiotics has dreamed up 'coffee without milk' instead of black coffee for example,
yet I am mindful that 'people with epilepsy' are mentioned here not 'epileptics' 'people suffering from schizophrenia' not 'schizophrenics'. I agree with this too, not labelling someone by their disease, recognising that they are more than just their condition that they present to you with, but does that not mean Shrink, you are conforming with some PC norms rather than rejecing them?

Shrink Wrapped said...

As a trainee psychologist, I prefer client.

Patient has too many connotations of weakness and need. It means to wait and be acted upon. Patients have things done to them.

To me, client denotes that my relationship with the person I am working with is not the same as a medical doctor. I am not going to tell them what to do. I am not going to do anything to them. We'll work together towards a shared agenda that is in line with the individual's priorities.

I think it is entirely appropriate and desirable for medical colleagues to call people in mental health services, patients. They come in, tell you their problems, you diagnose them and most likely you'll give them medication.

But its not like that for me. I don't diagnose. I put diagnostic labels to one side and try to come to an understanding of that individual's current difficulties, and then we work together. But in reality, they're the ones doing the hard work and that expectation needs to be set up from the beginning. That's why I prefer client for psychological work.

However, overall, I think it best not to get our knickers in a twist. So long as you are respectful and treat the people you're working with as fellow human beings, it is hard to go far wrong.

Lucy Hollis said...
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