Almost every industry has changed the term for the people they serve. We are now passengers, guests, members, customers, and more. The big exception? Health care. To those in the field, whether it’s clinicians or researchers or pharmaceutical marketers, we are all “patients” — even when we feel fine and aren’t in a hospital or doctor’s office.
It’s time to stop categorizing people this way, which puts them in submissive and dehumanizing roles.
Imagine what would happen if clinicians called the people they treat “clients” or “activated consumers” or “partners.” With that mindset, they move away from implying what they will do to or for them, and instead describe what they will do with them as proactive partners.
These new terms aren’t just more respectful. They’re more in touch with the times. Today’s activated consumers are ready to take more responsibility for their health care.
In a health care consumer survey conducted by my colleagues at Deloitte in April and May of 2020, just weeks into the Covid-19 shutdowns in the U.S., 72% of respondents noted that they understand their health and well-being needs and actively work with their doctors to set goals that work for them. And more than 50% said they are comfortable telling their doctors if they disagree with them.
Health is an essential resource and most people want to take charge of it.
With health care clients in the driver’s seat, they become the captains of their own destiny by working with a health care team they trust — and can communicate with — as partners in their health journeys. They hold themselves accountable for their choices, and they advance past today’s episodic interactions with health care to continuous connectivity, reaching out to their care teams whenever and however they need.
This empowered approach can help individuals transform their focus from disease to wellness.
When I opened my first primary care office in Tallahassee, Fla., my practice grew quickly. Fresh out of residency, I was younger than most of the adults seeking my care. To bridge any age gaps, I created a dialogue with them. I wanted to acknowledge my expertise about health care while also respecting their wisdom about their own health, bodies, and needs. I believed that having that kind of conversation could be the most significant way that health care providers set expectations for the client-care team relationship.
I sat down with each new client and said, “Your ship is your body, and you are the captain of the ship. Your job is to keep your ship in the best possible condition to take you through your life’s voyage. Your body is the only one you’ll get. You may have the opportunity to get a tune up, or swap a part, but you don’t get a whole new body. This conversation is to see if I qualify to be your first mate or adviser.”
I tried to quickly establish the roles we would each play in this relationship. I would tell clients it is my role to advise them, present a relevant care plan, prescribe the most appropriate medications and testing, suggest specialists when needed, and recommend the maintenance that includes preventive care and lifestyle changes. Their job is to decide whether or not to implement my suggestions.
The response? “You aren’t from around here, are you?”
A few people never returned. But those who stayed learned about their health as well as their ailments. We — the clients, their support networks of family and friends, and the clinical team that included several colleagues and me — worked together so clients could take more control and responsibility for their health.
Within nine months, our daily schedule was full and we couldn’t take on new patients. Despite having double the number of clients of other primary care practices in the region, ours had higher-than-average satisfaction scores. I was perceived as spending eight more minutes with clients than my colleagues, even though the reality was that I spent less time.
How was that possible? It was the way my staff and I managed our workflow, the structure of visits, and the processes we put in place so everyone could work at the top of their licenses. This left me additional time to focus on individual client interactions and listen to their concerns.
Our clients owned their care plans and, as members of the team, helped measure results and suggested adjustments along the way. That’s different from the way things work in most clinical environments, where several individual plans might be created by different physicians, often without input from the individual or their family.
Many, though not all, of our clients achieved significant results such as managing blood sugar and blood pressure, losing weight, and becoming more active because of the environment and culture we created.
It was exciting for me and my colleagues to watch clients learn and incorporate real-time care plans that not only slowed disease but, for those who changed their lifestyles, even reversed it. The people we most empowered ended up visiting us the least because they improved and better managed their health — as it should be.
Even though I delivered my first client-centric care more than 20 years ago, the idea of focusing care on the person — today it’s often called patient-centric care — is still in its infancy. From a humanizing health care perspective, prioritizing this shift creates rewards for all stakeholders, such as more satisfying experiences with the health care system, better outcomes, more efficiency in the system, better access to care, and a more sustainable ecosystem.
I have seen firsthand the advantages that can emerge from this shift and believe it is an essential piece for humanizing health care. By embracing a client-centric model, the various players within the industry will be able to restore the human connection in health care; empower clients to take charge of their health, disease, lifestyle, and care options; and inject compassion and empathy into the science of medicine.
To start this journey, it is necessary to consider people as “clients” rather than “patients,” a word I am doing my best to banish from my vocabulary.
Summer Knight is a firefighter/paramedic turned physician who has practiced emergency, urgent care, and family medicine; a managing director in the life sciences and health care consulting practice at Deloitte; and author of “Humanizing Healthcare: Hardwiring Humanity into the Future of Health” (McGraw Hill, April 2021).
As an old physician I still hold on some messages from Dr. Pamela Hartzband and her husband Jerome Groopman, N Engl J Med 2011; 365:1372-1373
DOI: 10.1056/NEJMp1107278, which I respectfully invite Dr. Knight to approach .
If Humanizing Medicine means to make it a bussiness profit profession (which I can not avoid as I translate the world client) then, at least for me, more than 50 years of UCI training and practice are in fire. (Please come back and use your firefighter skills and help me with it!)
In this era of ‘identifying’ in ways that make one more self-actualized (we’ve seen it certainly with physical gender; race and/or ethnicity, and so on)- this article certainly finds its home in such a narrative. In the early ‘60’s when ‘The Man from Uncle’ was popular television, I identified as Ilya Kuryakin who was a good guy spy, wore black turtlenecks, and carried a 45, and I channeled this persona halfway through 7th grade. The lovely woman who took care of my father in his final years was a highly trained personal caregiver, but identified as royalty, as her Amazon packages and such were addressed to ‘Princess’ so-and-so or’Grand Dame’ etc. My last visit to the doctor included a form where one could choose from SIX different genders, including ‘prefer not to specify’. This author is on to something: patients would feel less ‘submissive’ in the doctor’s office (I’ve only felt bored, personally) if referred to as ‘Commodore’ or ‘Governor’ the way London cabbies make their fares feel like big shots for a ten minute ride.
Not what you may want to hear but I see NOTHING wrong with the word patient… The most important thing is attitude…l think all this political correctness is a load of BS. Just leave stuff alone… Geeze… This world has enough problems.
I can’t think of any topic less important to write about other than maybe the fact that Katy Perry has announced she no longer has time to shave her legs…How about the fact that clinicians now spends hours on end documenting patient information that is already in the chart or that fact that thousands of patients undergo spinal surgeries which have been shown to be ineffective and results in higher rates of disability and narcotic addiction.
I am totally retired but continue to follow CME and enjoy comments such as Dr. Knight wrote. The practice she has and comments about including the patient in the first line of treatment options to be suggested are appropriate. I so not agree with the term “client” however. To me that is degrading and dehumanizing. A client is merely a paying customer and has little to say about the product sold be it medical treatment or the quality of permanent press trousers or legal advice. Bottom of the chain really. If they don’t like the term, they will shop elsewhere.
The advice given and rationale described by Dr. Knight is otherwise excellent. Listen to the questions asked and respond respectfully. When it starts with, “I read on the internet……….” be wary. Self-diagnosis can be dangerous. We must explain why repeated X-Rays can harm years down the road of life. Why some of the medications advertised, especially the OTC frequentlys say “This MAY help cure diabetes, cancer, heart disease, etc.”, all too often the MAY is overlooked and the list of side effects with other medication also ignored by the lay public. We know this and patience shown in explaining this usually is well recieved. Laughing out loud and yelling NEXT for another “client” will probably result in a lost “client.”
Teaching is key to all of us, be it MD, DO, NP or PA. Included would be lawyers, finacial advisers, physical therapists and mechanics. We chose Medicine and have hopefully become experts in the field. We become teachers as well as providers and leaders for the team.
In short, treating everyone as merely a client, i.e., a paying customer as the name implies, is disrespectful in my opinion. A compassionate and caring provider will garner a good feeling in retun for appropriate advise and explanations if needed and the practice will continue to thrive as will the patients.
Just my opinion. Dr. Knight looks out for those who seek her out. She is a good Doc in her outlook to include the patient in the treatment plan. I am just not fond of the lable client in medical practice.
Hospital administrators and billing staff love the term.
“Client” or “consumer” seem like terms that fit well into healthcare as a marketplace commodity. And in America, there is nothing less humanistic than the domination of capitalism over humanism.
“Provider” has similar problems. It sounds like anybody who wants to offer a service is the same as anybody else. It’s a good term for cellular or cable plan companies. But not in medicine.
The word “doctor” is derived from the Latin, docco, which means “to teach.” I cannot “provide” health to people like it’s a burger at a restaurant. I can teach them how to get there.
Patient comes from the Latin “patiens,” from “patior,” to suffer or bear. It evokes empathy and skill to ease the struggles of people who come to us seeking the best information and heart and competence we have to offer. They often hold the tools to heal themselves, and we are there to teach them how to use those tools, along with any medicines or surgeries.
Health cannot be consumed. It lies within each patient.
Many years ago I considered such a client based approach in medicine, then I realized the glaring flaw in that idea. A client chooses the professional whether an accountant, an attorney or even an interior decorator. They present with a set of goals and needs to address.
I can see why Dr. Knight has such a notion in primary care, most likely NOT hospital based in any way where such a notion may work. However, in the world of acute care medicine in the hospital setting these types of patients may arrive, but so do the geriatric, psychiatric, dementia, overdosed or other patient which does not have capacity, and therefore cannot be deemed a client, but a patient. This goes for the outpatient setting as well. Would you call the 5 year old your client? No. They do not have capacity to engage in a meaningful exchange of goals. The parents are the clients then, the child is the PATIENT. Same goes for a patient from a nursing home, or group home, etc.
The term patient is still appropriate and useful, while the term client has application. The best tactic is sticking with the patient centered approach which encompasses all worlds. The term patient is still the best term, just the application needs to change.
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