On the other hand, for some therapists, their non-use of "patient" is a disavowal of what they see in the doctor-patient relationship: a power relationship dominated by the doctor. They are right (see Informed Consent andObedience to Authority). But back to the first hand (second round of "on the other hand") --- as a physician, I really do have patients, and we physicians risk losing too much if we let go that word, which symbolizes a sacred trust.
So I can only say: I work for my patient. My patients should feel free to fire me if they don't like the care I am providing. And I don't dictate the terms of their taking meds. Instead, we discuss the physiological properties of various meds, the patient's reactions to them, and how the patient wants to take them. With many meds, I simply give some advice based on what I know, and the patient adjusts doses and timing independently and lets me know later.
Bottom line: the patient is the boss.
Since I wrote that in 1996 or so the phenomenon of "consumerism" has come to my attention. Oh my.
Even more poignant: I was recently exposed to New Hampshire psychiatry. Very sensible state laws. Very sensible practices. But the state mental health bureaucracy has embraced the consumer model of mental health: doctors provide services and "consumers" (patients) consume those services. As a local consumer-in-chief put it, "I’m out to get all the services I can!"
And after I got home a man came into my office. I asked him about his chief complaint (doctor talk for "Why are you coming to see a doctor?"). He told me - - - I am not kidding - - - "I’m a consumer of psychiatric services." It took me quite a while to pry out of him that he was chronically anxious and wanted me to prescribe him Valium. He needed it quick because he was going to Albany for a consumer conference.
The key thing that these people seem to be looking for is a way to get some power in what for them has too often been a one-way relationship - - - doctor knows best; shut up and take your pills. Next.
The consumer movement also seems to hold out the false hope that psychiatrists will stop throwing people into hospitals against their will.
So powerless people look for ways to acquire power. Consumers have power. Let’s be like them. Let’s call ourselves ‘consumers’.
The first thing I thought was that consumers required literally an act of Congress (the Consumer Protection Act) to help them get what little power they have.
I’m sure managed care organizations (MCO’s; they are NOT in any way HMO’s - - - health maintenance organizations) want you to think of yourselves as consumers of medical services. After all, they call us "service providers." But when you are sick, do you really want to seek help from a corporation that makes more money when it limits the help you receive?
Patients expect me to act like a doctor, not like a service provider.
When doctors act like service providers, patients are more likely to sue them for malpractice. Juries and judges think of doctors as doctors and not mere providers of services.
And what kind of "service" is it when somebody locks you up because you are dangerous? Psychiatrists have to do that because it is written into the law, and no re-labeling patients as "consumers" will allow a dangerously ill person to avoid getting locked up when that person is brought to an emergency department.
Finally, the term ‘consumer’ is governed by the relationship of businesses to their customers. As that goes, so too will that label.
It would be better, I think, to call a spade a spade (it is not a shovel), a doctor a doctor and a patient a patient. Then we could spend our energies making that relationship evolve in the direction we want. If you look at what I wrote in 1996, it pretty much anticipates the goals of the consumer movement. We doctors don’t have to be high-handed donkeys, after all. We are capable of changing to meet our patients’ needs. If patients demand that we change, we will.
In the mean time, outpatient treatment planning folks are calling their charges "participants". It seems that a ‘consumer’ is too passive. A person who is the center of a multi-disciplinary treatment plan needs to participate to make it work. I like the concept - - - for treatment planning.
As for me and the people I treat, I refer to them as my patients, and they call me their doctor. I do the best I can for them. It’s why they come to see me, after all.