What's in a name?

I recently read an article based on online-discussions regarding terminology in the health care sector which has given me food for thought.  The discussion was prompted by a post from Stephen McMahon, the CEO of the Irish Patients Association, where he expressed his concern with the use of the word “consumer” instead of “patient”.  McMahon’s argument hinged on the fact that the term “patient” has immediately recognisable connotations of identity, and thus it cannot be dispensed with.  What followed was a flurry of responses, supporting the use of the terms “consumer” or “patient” or suggesting an alternative term.

Those in support of the term “patient” were confident of its ability to demonstrate the service nature of health care.  “Consumer”, its detractors felt, made the focus too corporate.  Another facet of the pro-“patient” argument was that patients, unlike consumers, lack the freedom to change services if it does not meet their needs or expectations.  Those in favour of “consumer” asserted that a consumer by definition is active, and is in possession of the power to make decisions.  Other respondents rejected both of these terms as inadequate and instead proposed alternatives, such as “principal stakeholder”, “health service user” or “customer”.

I found the discussion around the alternative terms to be quite thought-provoking, as I had previously only assessed the debate in terms of the patient/consumer dichotomy.  The argument for the use of “principal stakeholder” was compelling, as it highlighted the central role of consumers in the provision of services, and the duty of governments to remember their obligation to the people.  “Health service user” is a term that has risen in popularity in Europe as an alternative to patient and consumer.  This suggestion emphasised just how much the wider debate about terminology focuses on the English language, with little regard for diverse cultures and languages. In Greece, for example, the term “consumer” is linguistically incompatible with the provision of health services, thus prompting the rise of user-based expressions.  

Proponents of “customer” identified it as the appropriate term because it denotes greater empowerment than either patient or consumer. However, it still runs into the issue of the lack of freedom of movement regarding health services.  While not widespread internationally, the term of preference in France is “ill person” (personne malade), as it first recognises the patient/consumer as a person, with the psychological, social and economic factors this entails.  However, this term is not necessarily applicable across the board, especially for those who do not see themselves as “ill:, i.e. those living with chronic conditions. 

The only conclusion I can definitely draw regarding this debate is that there is no simple answer.  Terminology is important, and those that bemoan its futility, because it achieves no “concrete” improvements, are missing the point.  Language shapes the way in which we understand the world, and the words we use in the context of health care impact on the mindsets of clinicians and consumers/patients.  From my perspective, the term patient is too narrow as it fails to encompass those who are not “ill”, such as people living with chronic conditions, and it denotes a sense of passivity to those it labels.  “Consumer” may not be the perfect term, as it implies the power to change services which we may not possess, but at least it signifies the ability to be considered as engaged, educated and empowered partners in the delivery of health care services.

Heather McGowan

Consumer Representatives Program