What's in a name?

I've been thinking about this for a couple days.  I know, sometimes I think too much.  I can't help it.

As many here know, I think words are important.  What words we use to describe something or name something affect how we think and feel about it.

So I was thinking about how we refer to ourselves in relation to our physicians.  Usually, people are referred to as patients when they are receiving medical care.  And that is actually one of the definitions of the word (yep, I looked it up) - someone that is undergoing medical care or treatment.

But in some situations these days, medical professionals are referring to their clients, not patients.  When I did home health care, I visited clients in their homes, not patients.  Mental health therapists often refer to their clients, as well, not to their patients.

So I looked that word up too.  And it means someone that is using the professional services of a professional (such as an attorney).  But when we visit a doctor, aren't we using his professional services?  So what makes us patients instead of clients?

And why does it matter?  I don't know if it does.  But being a patient brings up images for me of someone that is passive.  And being a client brings up images of someone that is in control, someone that hires a professional to provide a service.  Which is what we do when we see a doctor.

And then I thought about a friend of mine that worked for a while for an agency that provided job training for people with disabilities.  For a while, she and her coworkers referred to the people they served as clients.  Then someone decided they should refer to them as consumers.  They were people purchasing a service.  And when we see a doctor, we are purchasing a service, right?  And the word consumer to me brings up images of someone that has choices, someone that can comparison shop and choose the service or service provider they like best.  And maybe we don't always have much choice in what doctor we see, but often we have some choice.

So.  What are your thoughts?

Kelly

You already know my approach to how I handle doctors and as a whole my "medical team" of folks...so I generally think of myself as a consumer.  My doctors are basically a hired gun.  I go to them for a specific problem or to manage a specific set of symptoms/issues.  I am purchasing a service and with any service I purchase, I expect certain things.  I expect to be treated with dignity and respect.  I expect to get the appropriate value for what I pay for..and if not, I as a consumer I can and will take my business else where.

While I generally don't agree with the consumer driven health care industry....I operate within it because of its current structure.

The downside of this is that this is one reason why health care in America is so expensive. People want what they want even if there is no evidence to support it. Because they see themselves as consumers or clients they think they should get the treatment they read about on the Internet or the treatment their friend got even though there is little evidence to support it's use. This is a huge problem in America. The Institute of Medicine is attempting to address the problem that so much of the "care" we give isn't supported by fact but a combination of habit and patient preference.

Research tells us that antibiotics for viral infections are ineffective if not dangerous because of increased resistance of organisms. But, so many patients not only request but demand them that we're running out of effective antibiotics because there are so many resistant diseases now. How about the fact that research shows no statistical significance in improvement of ear infections in children treated with antibiotics vs allowing them to resolve independently. Sure, it take 1-2 days longer to recover without antibiotics but no one is willing to wait. Unfortunately, parents basically demand antibiotics and so they, as consumers, are given them.

It's a difficult balance between the rights of individuals and the role of the health care provider. My patients/clients/consumers will get angry with me when they're short of breath because I can't "fix" it. Never mind that they smoked 2 packs a day for 30 years. They want a solution. The truth is that sometimes there aren't solutions. People aren't happy unless they get an xray or CT scan even though, for example, a bulging disc can be palpated or simply treated without such a costly test- but we do it anyway. There needs to be more balance. In our "the customer is always right" consumer-oriented society we're being set up to have a lot of money spent on tests and medicines people request even if they're not necessary or even effective.

The person who is short of breath that I described will never be happy with my care because the reality is that the "service" I provide is never going to help them the way they want. People want solutions and when people consider themselves customers in a way they think they deserve a solution even of one doesn't exist...because they paid for a "service" they think it should work out the way they want. But, health is fragile and the truth is we may not like it when our doctor says we're killing ourselves by being obese or smoking or whatever...but it's true.

So, I'm blabbing incoherently here... The end of my rant would be this: In health care what we want and what we need are very different. People are used to having power and getting what they think they need as consumers. But in health the customer is often not right and it's difficult to say that another test, or drug, or procedure won't make a difference... no one wants to hear that. (OK time to stop. I have to write a paper for grad school and this is more than I've done for it!!! Very interesting question though...)

But doctors do not have to order unnecessary medications just because a patient asks for them.  In fact, I think they shouldn't because they are supposed to "do no harm" and prescribing unnecessary drugs could be harmful.

I do wish more of the medical care we received was based on fact.  In addition to the care sometimes being based on habit or patient preference, I see it often being based on doctor's preference too.  For instance, surgeon still recommend Flintstones for their patients even though the facts tell us that an incomplete children's vitamin like that is not adequate for RNY patients.  Yet surgeons still recommend them because that's what they've always recommended and because they like them.

I don't think it's difficult to balance the right of individuals and the role of the health care provider.  I am a consumer of health care services and I have the right to request any treatment I think would benefit me.  I also have the right to refuse any treatment I think is not in my best interests.  I also have a right to complete and accurate information about all my treatment options.  Now, just because I have the right to request any treat I think would benefit me, that does not mean my doctor must prescribe or perform that treatment.  But as a consumer, I have the right to discuss it with my doctor and I have the right to request it.  If my doctor will not do what I want because she thinks it would be harmful to me in some way, I also have the right to see another doctor for a second opinion.

I see the role of my health care providers as providing me with information, recommending the best treatment that they know of, ordering tests and procedures as needed and perform procedures as needed.  And of course diagnosing health problems fits in there, too.  But it is not their role to make decisions for me or to try to make me do what they think I should do.

I don't think it's that difficult to balance the rights of the patient/consumer with proven medical knowledge.  I think the BIGGEST hurdle to this is most often the doctors themselves.  Many doctors are over booked and when you only schedule 15 minutes per patient, its harder to talk to people and explain WHY XYZ test isn't needed or WHY an antibiotic won't work for a virus (although in 2011, most people SHOULD know this as much as they talk about it on the news).  So rather than get behind in appointments or schedule patients farther apart, doctors write scripts for meds that aren't needed or order tests that shouldn't be done just to shut the patient up and keep the assembly line moving.  Let's be honest here, doctors benefit the MOST from a consumer driven health care industry...which is why most doctors and pharmaceutical companies are so opposed to universal health care.

I can't speak for other folks...but I'm usually just as informed on my medical conditions as my doctors if not more so.  I am a board certified toxicologist that used to work in pharmaceutical research before joining the federal government (I work for the FDA).  I'm well versed in how most drugs are created and what pathways they affect in the body.  Usually, I'm educating my physicians about WHY XYZ drug isn't something I'm interested in taking.  I've turned down more antibiotics than I care to mention...and usually the doctor prescribes without me asking for them as a "precaution".  For me...because I don't take them often..when I do...they kill off EVERYTHING and it's months before my system self corrects. 

I don't think the "blame" for the current state of health care can be heaped solely on the doorstep of the consumers.

You make good points.

I'm sure it is hard to do much education with patients in a 15 minute office visit - and I've had many doctor's visits that did not last that long.  And I understand all the reasons doctors feel pressured to fit so many patients in during one day so it's hard to give patients more time.

I am often better informed than my doctors on certain subjects.  Certainly not on every aspect of medicine.  But I do know more about RNY than my PCP does or more than my psychiatrist does, and I know more about vitamins than they do.  And I want to see doctors that respect my knowledge.  And I respect theirs.  

Kelly

I think that's the key that is missing in the current healthcare industry...patient education.  Usually patient education comes too little too late...and usually AFTER a chronic disease diagnosis that honestly had the patient been educated EARLIER,  might have been avoidable. 

Honestly, I haven't given the language aspect of this much thought, though you make good points.  When my youngest dd was ill, I had a falling out with her neurologist..... to the point that I was reminded that I was on camera - which didn't bother me.  A friend recommended this book:

http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0 547053649/ref=sr_1_1?s=books&ie=UTF8&qid=1320262125&sr=1-1

It makes some wonderful points and discusses how you can take charge of your healthcare -- in the way you're describing as being treated as a client or consumer.  I now think of my dr's in the same way that I think of my auto mechanic -- if they can't fix it on the 1st or 2nd try, it's time to go elsewhere.

I just wanted to point out that sometimes its not about "fixing" or even a "cure" with medicine.  Sometimes its as simple as managing the progression of a disease or even reversing the current effect (or is it affect?) of a disease.  I think "fixing" is very relative to the disease/illness. 

I think when patients are educated on thier particular disease/illness and know what the standard outcome/goal of different courses of treatment are they are better able to participate and take an active roll in thier care.

I also think that a LOT of doctors are unwilling to admit when they don't have a CLUE what is wrong with a person.  They would rather try a little of this or a little of that and reach a diagnosis of exclusion.  I personally HATE that.