Patients and clients

We write to register our disquiet at the use of the word ‘client’ instead of patient in the pages of the British Journal of Psychiatry (e.g. Marsden et al, 2000). The choice of words has far-reaching consequences, and we believe that this change in usage represents a shift in our relationship with patients, and erodes professional standards. We would like to point out that patients themselves prefer to be called patients, rather than clients, customers, consumers or service-users (Upton et al, 1994).

The word client is derived from the Latin verb to hear or obey and referred to a commoner who was under the protection of a patrician or patron — a relationship that was by no means equal. The current dictionary definition captures this relationship well and gives neither side their proper dignity. The Oxford English Reference Dictionary (Pearsall & Trumble, 1999) defines client as “a person using the services of a lawyer, architect, or professional person other than a doctor, or of a business; a customer”. It is a term also used by other, not always very professional, callings.

We note the word is already used widely in documents from the Department of Health, The Sainsbury Centre, and other social research and planning groups but, none the less, we think that it should be resisted, particularly in our own professional documents. We ask the Editor to address this as a matter of policy. We would also like to encourage other psychiatrists and professions related to mental health, including managers, to use the word ‘patient’ in their local documents, as we have succeeded in doing in our own Trust.

This is a change in the use of language which only serves to muddy the waters of our professional work. Not to address this issue, whether through exhaustion or a misguided attempt to please non-medical colleagues, is to collude with this process. Our relationship with our patients is the cornerstone of clinical practice, and we should be fighting to maintain it.