What's in a name? Patient, survivor, client

Now here is something the Chancellor's axe could fall upon without pain or loss in his endeavours to alleviate the nation's debts! I am astonished that anyone should spend money - let alone time - on such a futile piece of pseudo research. ¹

What does it tell us? That out of 336 ‘receivers of mental health services’ in east Hertfordshire, the majority, just like their counterparts in London, would rather be called patients or clients than service users or survivors; and that the term patient seems to be more commonly used in dealings with psychiatrists, whereas social workers favour service user. How many times in my 20 years' experience attending my son's ward rounds have I listened to the consultant refer to the patient, while the social services people in the same meeting refer to him as the service user!

But this should come as no surprise. Psychiatrists have been trained as scientists, brought up to identify things and call them by their proper names. Social workers appear to have been trained in a junior branch of social engineering, the offspring of a curious miscegenation between the politics of positive discrimination, which sets out to eliminate anything that might be construed as judgemental or in some sense relegating people to a category of inferiority, and the language of consumerism which emphasises individual freedom of choice and the inalienable right to shop around and find your own bargain.

Language is there to be manipulated. A couple of years ago the CEO of my local mental health trust stopped referring to ‘your son's illness’ in correspondence and began to speak of his ‘recovery journey’. When I suggested that did not seem terribly appropriate where schizophrenia was concerned she referred me to the website of the Social Care Institute for Excellence where I learnt that ‘In ordinary speech, recovery is often (sic!) equated with cure’, but that of course is an outmoded way of looking at the matter when severe mental illness is concerned; in effect, if you think you have recovered, then you have.

But has anyone stopped to consider why patient might be construed as excluding anyone, as being in any way derogatory or demeaning when applied to those ‘receiving mental health services’? Cancer patients do not seem to find it so. Nor, as far as I am aware, do they consider themselves to be ‘receiving services’. They are not well and they go to the doctor in the hope that he (forgive me, but this is a gender non-specific pronoun when used in this sense in English) will make them better.

The crucial definition of a patient is one who suffers, who endures an illness, who is acted upon rather than acts. Most of us, on the basis of modern advances in science and of several decades of pretty successful practice, are happy to go to a doctor trusting in his knowledge and in his commitment to making us better rather than, say, exploiting us as potential sources of income.

Client signifies a very different kind of relationship. Who in normal life has clients? Solicitors, management consultants, call girls, architects. Although it is sometimes used merely as a posh word for customer, the essential difference seems to be that a client is buying a service and himself defines what he wants. The provider of the service seeks to keep his client happy by giving him what he wants, even if it means doing a little creative accounting or throwing in a lunch in an expensive restaurant. The client is the one who calls the shots. Not, surely, the kind of thing one expects of the relationship between someone who is not well and his healer.

Tinkering with terminology may amount to little more than a foolish waste of public money if we are talking about people a little bruised by life. If it distracts from providing proper treatment and care for people who are seriously ill, then it begins to look rather like Nero's fiddling as Rome burned.