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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  • DoubtfulGuest

    Nice post. I consider myself a patient for the same reasons you describe. Very well said.

    • Janet Byron Anderson

      Thank you for your comment. I can be treated with respect as a patient, or treated with contempt as a consumer, client, or whatever. I wouldn’t want docs or other providers to get by with just changing the term without changing their attitude. We’ve all had sad experiences of this trap. Analogy: “Ms”, in my opinion, has been a wonderful linguistic improvement in our terms of address. Yet many a “Ms” still endures sexual harassment in the workplace! Decades ago, people in (or excluded from) authority should have first started treating women with dignity. If that had happened, we wouldn’t have needed “Ms”, because every “Miss” and every “Mrs” would have been treated with respect. As a linguist, I’m tolerant of language change, but as an observant adult, I know how cunning people in authority, or in power, can be: “Just call them [women, blacks, older people, and other 'subordinate' classes] something ‘respectful’, and they’ll accept it as a substitute for real social change”. Language is too precious to be misused in this way. Thanks again for responding.

      • DoubtfulGuest

        Good points, I agree.
        I think the effect of customer service terminology on our doctors/NPs/nurses/techs matters, too. Their jobs are way too hard already and why bother if they’re going to be talked to like they’re indentured servants?

        While we’re at it, I don’t like “provider”, either.

        • Dana Freedman

          I was just going to make that point about the term “provider” myself. A “medical provider”, often shortened to just “provider”, could be anyone from a dietician to a surgeon, it’s a very generic term and obfuscates, rather than clarifies, our roles.

          • DoubtfulGuest

            Like there needs to be any more confusion in health care…esp. for, e.g., elderly patients w/dementia who could feel overwhelmed by instructions from different people…now muddy the waters about WHO is advising you to do what and why?

            Also, I think the term puts emotional and moral distance between us, not a good trend at all for solving problems and addressing mistakes in a reasonable way.

          • Janet Byron Anderson

            Hmmm. You and “Doubtful Guest” have done me a favor: I’d never given thought to “provider” from a linguistic perspective. But I’ll now jump on it. My gut tells me surprises are in store. Thanks!

          • DoubtfulGuest

            Should be interesting. I’ve personally experienced that word used by HC corporate admin to try to flatter me, then stonewall me, in a risk management situation. Didn’t even know what hit me til it was too late.

            “So, are you still wanting to keep him as your PROVIDER?”

            btw, I like “Ms.” because it’s straightforward, but otherwise agree with you.

          • DoubtfulGuest

            You know, until you said something, I wasn’t even aware that this term was being used so non-specifically. When did this start, do you think?

          • Janet Byron Anderson

            Thank you for the question. You’re referring to “patient”. An interesting set of terms, all from Latin, were borrowed into English beginning in the 13th century and into the 14th. The core sense of all these terms was ‘being subject to’, ‘suffering” or ‘enduring’. Now, one can suffer with or without complaint, with or without self-pity. However, in an earlier time (e.g. medieval), it was considered moral for one to endure suffering heroically, without complaint. This favorable connotation of suffering was certainly encouraged by religion, but the harshness of life played a part too because energy spent complaining would have been better spent surviving. Heroic suffering is not a cultural value in the modern era. To my knowledge, such suffering is now routinely confined only to warfare and childbirth. Otherwise, except for pockets of poverty and deprivation, Western culture is easy on us, and we’re less tolerant of suffering. The noun sense of a person who is suffering (undergoing) medical treatment specifically was a late (14th century) development. This “patient” was expected to be “patient” in suffering, to endure heroically. Given how comparatively primitive early treatment was, and how grim the prognoses, suffering heroically made sense. In this era though, being modern people, we expect to be relieved of pain. If I were transported to Old English times with these expectations intact, I would be a wimpy, complaining Anglo-Saxon woman!

          • DoubtfulGuest

            Thanks! I was also asking about “provider”, or rather when exactly the switch to provider/customer really started to take hold instead of doctor/patient. It will be interesting to see your follow up piece on this topic.

            Your comment here highlights the main other reason that I still prefer the term “patient”. I have a chronic illness that requires ongoing care, and need my doctors to remember that I am in fact suffering (although not nearly as badly as many others who post on this blog). I’m still trying to deal with a situation in which I was misdiagnosed (which led to some actual harm). The doctor deceived me about what went wrong and to this day refuses to explain anything or apologize. This happened in the setting of corporate health care. At some point without my knowledge, I lost my status as patient and along with it any moral/ethical obligation my doctor might have had to me.

          • Janet Byron Anderson

            That was a bad experience, and I’m sorry it happened to you. I hope you’re now receiving better care, and I wish you good luck. As to “provider”/”customer” and when these sneaked in, I don’t know. But as I said, I’m going to look into this side of the issue. Seriously, because I hadn’t thought of this before, and I appreciate the suggestion. And you’re on target with the question “when?” because in my experience as a linguist, I find that answering “when?” gets one halfway to answering “why?”. I’ll definitely keep you and others informed, and might [Kevin permitting, of course!] post again on this site. Thanks so much for your involvement with the discussion.

          • DoubtfulGuest

            Thank you. “Patient” is important, too, although I’d guess that most here might agree with your definitions and why we should leave it alone. It’s easier to focus on words we don’t like and why…then there’s more to argue about. :)

            I was also asking Ms. Freedman when she thought the term “provider” started to be used so generically. Probably this shift coincided with the new terms substituting for “patient”. I had the impression that she’s an HC professional other than a Dr., so she would have an interesting take on this issue.

  • DoubtfulGuest

    No third-party payor? If only it were that simple.

    I’m actually with you on making decisions (as much as possible). My pet peeve is when a doctor says “I’m gonna put” you on this medication.

    • Janet Byron Anderson

      “I’m gonna put you on” — as if we were cars that we “put” gas into. I’ve heard this a few times myself, and always asked Why? What’s the alternative? the drawbacks? The essence of empowerment is engagement — the willingness and guts to ask questions even of those who have more clinical knowledge that we do. My doc might understand much of my anatomical nitty-gritty more accurately than I do, but I’m the only one who understands ME. Therefore it’s legitimate–and a moral obligation–for me to refuse to “put up with” whatever she wants to “put me on” !! Thanks for your comment.

      • Dana Freedman

        And what about the nanny’s “we”?
        “We’re going to have to try to do better at monitoring our blood glucose.” WE? OUR?

        • Janet Byron Anderson

          So true! Thanks for mentioning this. We’ve all heard of the “royal we”. Translate: There’s so much of ME that I have to speak of myself as WE. You’ve called our attention to the condescending WE. Translate: In my opinion, there’s so little of YOU that I have to fatten you up with some of ME. YOU + ME = WE.
          A valuable contribution to the discussion. Thanks!

  • Janet Byron Anderson

    Thank you for your comment! I too pay for services of a physician, make decisions regarding my health, etc. but I do so as a decision-making, empowered patient. I could decide (and tell my doc) that I want her to consider me, and to call me, a consumer (or other term), but if she TREATS me, socially or clinically, as an unempowered person who must comply with all her recommendations, I’m no better off for calling myself, and having her call me, a customer, consumer, or whatever. In fact, the doc could easily delude herself into thinking that she’s empowering or respecting me simply by referring to me with a term that connotes empowerment. Finally, even as one who makes decisions about my healthcare, in many instances I need reliable clinical information, which I am NOT in a position to generate in their entirety [Dr. Google notwithstanding], tests that I am NOT in a position to make myself (no skill, no laboratory, no equipment). Thus my autonomy is limited. But for me to feel unempowered or subordinate because of these limitations would require a decision on my part to FEEL unempowered and subordinate. The situation itself (no skill, no lab, no equipment) doesn’t have the power to make me feel this way. Thanks again for your thoughtful response.

  • DoubtfulGuest

    That’s a great read below, thanks Dana. This definition is helpful too. “Health care providers” as a category doesn’t sound so bad, maybe and kind of interchangeable with “professionals”…but any use beyond that does sound, like the article says, “demeaning” to the highly-trained, hard-working people it describes. I had no idea patients were actually using the term “provider” during checkups and visits. Spreads like wildfire…

    I wish Kaya5255 would check back in here, as we may actually want some of the same things, we’re just labeling it differently.

  • Howard C. Berkowitz

    The name does allow me to refer to myself as an impatient, which I find useful at times.

  • Janet Byron Anderson

    Thanks, Dana. The more I’ve read the comments here, the greater the need I see for “provider” and related terms to be given a thorough linguistic assessment, not only contemporarily but also historically. It’s nearly impossible to understand a term–or even other things–without seeing everything within context, within the big picture. I’m grateful to readers for stirring me up on this subject, and I’m going to work on it. I’ll submit the results first to this site and perhaps [cross fingers!] Kevin will find them appropriate for posting. Thanks again for your useful information–and for the inspiration.

  • Janet Byron Anderson

    Dana! Thanks for this reference. I had not read this article, but will do so and include the authors’ insights (as well as those of others) in the “mix” when I work on the provider piece. I’m so grateful to you readers for your inspiration and insights. Incidentally, if you think of anything else and you’re not on this article’s page, you can reach me by email at medlinguistics@sbcglobal.net I’d love to hear from you.

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