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It's Time to Retire 'Patients'

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You've probably heard the old joke. There's a long cafeteria line in heaven -- suddenly, a majestic figure runs to the front of the queue and "cuts in."

"Who's that?" says one irritated angel.

His friend responds, "Oh, that's God. He thinks he's a doctor."

As recently as 10-20 years ago, the joke would have resonated with doctors and patients alike. Since their inception, medical schools in the U.S. had been designed as a health care version of the marines. Fresh-faced young men had been admitted to an "Officer Candidate School" of Medicine, had been given white coat uniforms, spent years being torn down by aggressive drill sergeant-esque attending physicians, and were finally built up upon graduation to join the elite corps of "The Few and the Proud -- the M.D.s." Only these privileged apprentices would then be privy to medical knowledge and given the keys to be able to serve as our society's shamans and medicine men. Patients, the health care "laity," when ill or injured, would have to turn to their exalted physician for carefully parceled, shrouded wisdom.

The etymology of "patient" stems from the Greek verb πάσχειν, to suffer, and the Latin present participle patiens, one who suffers. Those unfortunate enough to be struck by the painful fate of trauma, infection, or disease, submitted themselves at their most vulnerable to the laying on of hands and the direction of the doctor, whose title has its roots in the Latin verb docere, to teach. The historical perception that the suffering patient was in some way responsible for his condition contributed to a sense of shame and guilt, and drove patients to approach their physicians with patience, defined as the "calm, self-possessed, and unrepining bearing of pain, misfortune, annoyance, or delay." (Certainly, the latter, as many overcrowded waiting rooms can attest.)

The kindly family doctor, well-known in his community, who carried his black bag from house to house was likely to be a more humble part of the fiber of a village. But most doctors who survived the indoctrination of their harsh and lengthy training, which included brutal hours in the battlefields of emergency medicine, developed emotional armor to shield themselves from the tragedy of death and loss. By objectifying their "patients," and directing their healthc are through "orders," physicians could maintain the illusion of control over many situations which could not guarantee a positive or even satisfactory outcome.

Many patients, in turn, welcomed the opportunity to relinquish themselves to a "Higher Power," one whom they perceived would be caring and would save them from dire distress and fearsome death. This often consensual hierarchy would also allow patients to relieve themselves of guilt as well as responsibility for the steps necessary to promote recovery. Because their patients were not schooled in medicine, many physicians promoted this dependency rather than using the encounters and visits as opportunities to mentor their patient patients towards greater understanding and self-care. However, the significant numbers of medical errors that have been documented, as well as the ongoing reports of physician negligence, malpractice, assault, and fraud have pulled back the curtain on the impeccability of health care wizardry and have openly displayed flawed humans in the projection booth with feet of clay.

Fortunately, the profound changes in health care over the past two decades have led to greater transparency and improved quality of care. Even medical education programs have now accepted the evolution towards a less hierarchical model of modern health care, which is comprised of multidisciplinary teams of men and women providers in a variety of health professions, including medicine, nursing, pharmacy, psychology, and ancillary services, along with patients and their families. Family-centered care that includes culturally competent and comprehensible education of patients and their caregivers about their health, and engages patients and families in a partnership with health care providers, is the wave of the future.

Additionally, health information in the Internet Age is no longer limited to a select fraternity, but is available literally at everyone's fingertips. Consumers of health care may welcome the opportunity to consult with a medical expert to analyze and discuss the best course of action to manage their health, but don't always need to. If they choose to seek consultation, consumers should be able to do so in a collaborative environment with their physician. But, as consumers, adults seeking care should be treated with courtesy, dignity, and respect, and retain their rights of choice and consent. When doctors (and other health care providers) call customers purchasing a health care service "patients," they are labeling consumers as compliant sufferers (a submissive and passive role) and undermining their independence and initiative.

It's time for doctors and other health professionals to take a page from our psychology colleagues and acknowledge that we are vendors of services for which our "customers" or "clients" employ us. A "good bedside manner" today should incorporate the essentials of good customer service -- and it is the word "service" that is key. It is we who should be "serving" our clients, and not expecting them to obey our orders or comply or "adhere" to our recommendations. Calling our clients "patients" is an archaic vestige of a Jurassic vision of medicine in which doctors imposed "control." Recognizing that they are instead our customers will underscore the reality that they are in control and in charge of their lives -- and that our job is to help and support them achieve health and wellness as consultants and partners, not authority figures.

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