4 linguistic reasons to leave patient alone

For at least two decades doctors, caregivers, the people they care for, and advocates have deplored the term patient or have been exposed to the arguments of those who deplore it. “Patient” has few defenders in an age in which Western consumers of health care insist on an equal voice in the management of their afflictions, and loathe ceding all power to those who are dispensing relief. This blog recently published a thoughtful guest post by author Pat Mastors, who pleaded with us to coin a new term to replace the odious patient: We need a new word for patient.

“Be careful what you wish for,” goes the saying. Several linguistic reasons argue for our not getting our wish granted in this instance.

1. Patient signifies a role we play, not the whole of who we are. A role signifies some limited aspect of personhood. Consequently every term for a role is reductive, simplistic: It carves a slice from the whole of a life and highlights that slice in contexts that call for that slice — and only that slice. The other slices in the whole are irrelevant. At home or at a meeting of the PTA you’re mom or dad. But at a research hospital you’re a research associate. If you’re an outdoors type who belongs to a hiking club, to other members of the club you’re mainly a hiker, someone who shares their passion for the outdoors. If you’re temporarily laid up in a hospital because you’ve taken a nasty fall on one of the trails, you’re a patient.

These role names — mom, dad, research associate, hiker, patient — aren’t inherently demeaning. They can become so only if uttered to (or about) you in a demeaning tone or with a syntactic barb, such as the adverb “just”: Oh, she’s just a mom – and we all know how limited the horizons of moms are.  Even a status term can become demeaning if you’ve had a bad experience of the person: He’s a doctor. He understands the heart but he doesn’t have one.  Yet at home, where the man is a devoted father and spouse, he might reveal a whole lot of heart.

Every role term simplifies a complex person. But simplifying isn’t necessarily demeaning.

2. Objections to patient target its unfavorable meanings and ignore favorable meanings that are no longer significant in modern Western culture.  Would anyone object to being called a person who could tough it out, who persevered in a task, who didn’t complain but simply got down to business, who didn’t give in or give up? Yet these meanings of the adjective patient (from which the noun is derived) were common in the medieval period. Collectively these meanings reflected an older cultural sense that one could also suffer heroically – a sense that’s alien in today’s culture, in which all suffering is interpreted as the passive (and demeaning) endurance of pain. Today’s patients want control, not heroism. The term patient has thus fallen victim to unfavorable cultural bias.

Nevertheless we’re awed by heroic (!) patients who bravely carry on their lives — without complaint, without self-pity — even as they struggle with illnesses that would crush the spirits of many of us. At the same time, though, we’re frightened by the sight (or the experience) of the utter helplessness that attends serious illness or injury. Like it or not, there are times when one is thoroughly acted upon clinically, and lacks the agency implied in being a consumer, user, partner, client, or customer — all suggested alternatives to patient. Such real-world paradoxes are bound to make us impatient with patient, which has a maddening range of meanings, some of which are antonymous. We want patient to behave itself. But it refuses to do so.

3. Unplanned semantic change can yield meanings that we’re comfortable with, while leaving the term intact. The main criticism of patient is that it doesn’t connote the agency and control that real-world patients have, or hope to have. However, linguistic history shows that a term can survive with meanings that are radically different from those that earlier generations recognized. Changes in society, including occupational changes, lead to changes in the meanings of words. In the medieval period barbers often performed surgery, but social change and medical advances led to differentiation between barbers and surgeons. Nevertheless the term barber has survived, but with restricted meaning: The meaning ‘one who performs surgery’ no longer applies to it.

A similar unplanned semantic change is possible with patient. The term could survive, but with agency replacing passivity (which modern people dislike) as the key element in its semantics. Because of growing arguments against patient, it’s possible that a hundred years from now, speakers may be surprised to learn, researching the 21st-century etymology of the term, that it ever carried the connotation of passivity.

4. Patient has friends we’d have to deal with if we banished the term. Words aren’t used in isolation. They occur in context, and contexts cohere lexically and semantically. Patient denotes a person who’s receiving medical treatment for a complaint or illness. Several expressions co-occur with patient in context and along with patient, they contribute to the linguistic integrity of that context. If we meddle with patient, these other expressions will lose communicative reliability.

What would we call outpatients, inpatients, and day patients? *Outclients, *inclients, and *day clients? [The asterisk is used in linguistics before a word, phrase, or clause that a native speaker would regard as odd or unacceptable.] How should we regard the following sentences?  *The doctor is treating a consumer with diabetes.  *We want to improve hospice care for dying users.  *This drug doesn’t help all recipients. *The doctor ordered surgery for his partner’s injured knee.  *”I’m not a patient with epilepsy, I’m a customer with epilepsy!”

Patient is fine. It just needs time — and human pressure — to acquire meanings that more of us can live with.

Janet Byron Anderson is medical linguist and medical editor, and author of Sick English: Medicalization in the English Language. She can be reached at MedLinguistics.

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