Thursday, August 07, 2008

Please Don't Eat Me

The usual discussion revolves around whether those who seek treatment for mental disorders should be called "patients" or "clients."

So Roy and I were at a legislative mental health meeting and one of the people giving testimony kept referring to psychiatric patients as "consumers." Consumers? Okay, it's not the first time I've heard the term, but here it was used over and over (and over) again. Consumers. I suppose I think of myself as a psychiatrist who treats patients, and not as a 'provider' to 'consumers.' This meeting took place around the same time that one of our readers commented it was insulting when I referred to a patient with recent and repeated episodes of dangerous behavior as a "time bomb" after she stopped her medications precipitously. I was thinking about the power of language, the innuendo of words and phrases, and I was struck by the repeated reference to Consumers.

It brings to mind, for me, this odd anxiety that my patients will eat me alive. Doesn't one consume food or fuel? Does one consume psychiatric services? What exactly does one consume during a psychotherapy session? What's there at the beginning that's gone by the end?

Can someone please tell me why anyone would want to be a consumer rather than simply a patient? Please don't pass the ketchup....

Oh, and my graphic of the person eating lobster is in honor of Roy's vacation posts from Maine. Please, please, do consume one for me.


Dragonfly said...

Grrr, political correctness. Doctors I have worked with (who I agree with) I think that "clients" sounds so different to "patients" that they and I would rather use "patients" as a little protest against the "thereisnomentalillnessonlypeoplesinabilitytocope" chapter of the Flat Earth Society. I have had explained to me the rationale for using "clients" as sounding less "sick", but consumers is even more extreme. It can make it sound all rather voluntary and give the critics who rail against "therapism" more ammunition, which is not in the best interests of the patients/clients/consumers/utilizers. On the other hand if the patient/client/consumer/utilizer/therapee prefers to use a certain term (or the therapist/psychiatrist/psychologist)...let them.
*Climbs down off a bandwagon that she did not mean to get on*.

Anonymous said...

Seems like another attempt to further deteriorate the doctor-patient relationship. Maybe we won't mind doing a 15 min. med-check to a "consumer" as opposed to only spending 15 minutes with our patients... with whom we have a relationship of service. Out of curiosity, who was leading this change of language? Someone from the business perspective or a treatment provider...

Esther said...

I worked 5 years at a supercenter (similar to Wal-Mart, but way cooler) where we referred to all our customers as "guests." I never understood that mentality. What's so insulting about being called a customer? Guests are usually invited. I sure didn't invite any of those people to my store. Also, guests don't usually show up for the express purpose of purchasing necessities and luxuries from their friends' homes.

Ditto with the patient vs. client (or consumer) issue. It doesn't make me feel like less of a person because I have a mental illness (it's not that serious) and am referred to as a patient. Patient does not automatically mean that someone is a freak or bedridden. Just means they need some help to get better.

And no, I am not planning to consume any psychiatrists or psychologists. I make sure I get good protein on a daily basis. :oP

Anonymous said...

I once was in a meeting, in which that very topic was discussed -- ad nauseum. After about 15 minutes, someone asked me what I thought. I said, "I think we should call them people." No one said anything to that.

Today, I was leaving a med/surg hospital, and I passed one of the family practice docs. She turned to me and said, "Thank you for seeing my people."

Despite all that, I still think the people are patients.

Anonymous said...

I know that the idea is that someone with a mental illness "consumes" mental health resources, which to me sounds very strange.

Having worked with government entities on mental health issues, I've found that "consumer" is the word they are using.

I think "client" and "patient" is only accurate when it is used in the context of a person's relationship to a therapist or physician.

I'm curious if there would be a different word that would mean "individual with a mental illness" when that person is not referred to in a medical or therapeutic context. I don't know.

Awake and Dreaming said...

I have clients. Plain and simple. Current correct political social work language says I have consumers. I refuse to use that word. I think it's degrading. What, they can only use and use and use? No.

I am totally fine with psychiatrists seeing patients. That's cool. I'm my doctor's patient. I don't mind at all. In therapy, I was my therapist's client. Whatever, that's who I was. I can also be the client of a lawyer, a real estate agent, an insurance broker etc... what's the big deal?

bah on political correctness. I get so sick of it sometimes. You know what's not right? Homelessness, no matter what we call the people I work with, it's still not okay.

Anonymous said...

Good! One of my pet peeves!

I consider myself my psychiatrist's PATIENT. He's the doctor. I am the patient.

When I saw a Marriage and Family Counselor I considered myself a client (she was not a doctor).

In my PERSONAL OPINION, the term "consumer" is the patient's relationship to Big Pharma (they HOPE!) and they must have coined the term.

I was repeatedly solicited by NMHA (National Mental Health Association) to do public speaking on behalf of "the mentally ill". The idea is to show the public how "normal and adjusted" the ("formerly") "mentally ill" are. I was disturbed by their literature's repeated use of "consumer". Considering I do NOT take any psychiatric drugs I questioned them about what sort of expectation they had for my speech content. The REQUIRED format for speakers is:

1. I was mentally ill
2. I took these prescribed drugs
3. Now that I am on the drugs I am normal.

I declined. If I speak it will be for MindFreedom (AFTER I get tenure as a teacher). If I write a book about my experiences it will tell about my less than happy experience on psych meds plus my horrific hospitalization (something else I have strong feelings about).

Anonymous said...

As someone who has been in therapy, I have no issue with either patient or client as a descriptor. However, consumer makes me bristle. It relegates mental health services to little than a market-based relationship. I do not consume therapy in the same way I consume laundry powder. I see a mental health professional to receive care and treatment. And if “consumer’ is a provocative term, how about the term “service user” which I have heard bandied about.

ps for Maine lobster tasting, you can always check out the New England board on Chowhound for suggestions.

Anonymous said...


Even when I greatly believed in psych meds I hated the term, consumer. I hate it even more now that I am tapering off of meds.

We don't call neurology or cardiac patients consumers so why should psychiatry patients be called something different?

I am sure whoever coined the term had good intentions in trying to prevent stigmatizing people with a mental illness label. Unfortunately, I think the opposite has occurred as I think when you use a term that doesn't quite fit, it makes things stand out even more.


shraddha said...

Consumer = An individual who buys products or services for personal use and not for manufacture or resale.

The fee the person pays you are for the services you provide as a doctor!So the person is a consumer.

This would hold true for any speciality, not just Psychiatry.

Dumb old me can not understand the problem here.

But when you say 'time bomb' could mean to some, that you are suggesting ,that the person would be harmful to others like a bomb ticking that's offensive!


Anonymous said...

"Consumer" is not just being applied to mental health, but to health in general. We no longer have "medical insurance" at work; we have CDHPs (consumer-driven health plans). The hype being jammed down our throats is that the high deductible that comes with these plans ($2000 for a single person, $4000 for a family) will force us "consumers" to "shop around" for the best prices on doctors and lab services. Doctors and labs don't typically advertise their rates, so how many phone calls are we consumers expected to make to find out this information? And do we really want to use the doctor who charges only $15 for a physical exam in a back alley?

Dinah said...

I should probably just keep quiet, but the patient in the time bomb post had a history of violence when ill in the not-too-distant past-- dramatic episodes requiring a lot of intervention by a lot of parties -- so actually, that was exactly what I meant when I called her a time bomb.

shraddha said...

The choice of high deductibles plans are feasible for families who have mostly healthy family members and know that they will not be going to doctor too many times and this drives down what they pay to insurance every month as a premium.
Its a risk many families take knowing that if God forbid anything wrong happens, they might reach their out-of pocket maximum limits.
Its a risk i have taken for my family.( touch wood)
Generally employers give choice to decide, of what kind of plan is good for your family.
It could be high premium or high deductible.

shraddha said...

Dinah: looks like we were commenting right at the same time.

I have no problems about the time bomb thing.I was just saying what i gathered from all the talk that went on that day in comments...

Also sorry for commenting like 3 times here.I am sorry for bombarding the section with my stuff.I hope it was not too annoying.

And please keep on not be quiet.
We love to hear you, that's why we read your blog!

Aqua said...

AHHHHHHHH! Here in Beautiful B.C. Canada we are known as consumers. It makes me cringe and I feel angry and guilty inside everytime I hear the word. I am pretty sure I have ranted about this before...but seeing the word makes me want to rant again.

"Consumers" are vilified on this planet. Consumer use up precious resources. The word always brings to mind someone using and using and using...and never giving back. I HATE the word being used to refer to me as a psychiatric patient.

I am a patient. Period. If people call me a patient I become seen as in the same realm as heart patients, diabetic patients etc. Trying to make psychiatric patients different from any other kind of patient only increases the stigma, and differentiates us from people who have "real" illnesses...I hope you heard the sarcasm in that last stament. It was intentional. My illness is as real as any other. Many other illnesses have psychological and environmental and genetic components...think about people with heart disease, who cannot get themselves to change their diet and exercise regime, who have a family history of heart disease, etc.

I am a patient who sees a doctor. The end.

Anonymous said...

I agree 100% with aqua. I despise the term "consumer" and don't understand why NAMI and similar organizations love using it. Medical treatment is not fundamentally about a purchasing transaction, even though obviously there are fees for services. Using this term distorts and cheapens doctor-patient interactions and the essence of medical care. I would think that the best way to reduce stigma surrounding psychiatric illness is to equate it to any other medical problem -- hence, the using the accurate term "patient."

Unknown said...

Just a guess, but, I'd bet that "consumer" was conceptualized as a term to empower psychiatric patients (i.e., fight the stigma of mental illness). Not a bad idea at the time, probably. Knowing the number of patients I have that have had no idea what their dx. was, or what their meds were (let alone for), some empowerment was certainly in order. However, the term appears to have outlived its utility, though, in a world where antidepressants are dispensed like M&Ms.

Anonymous said...

I believe there have been some misappropriations of economic and marketing jargon into the medical lexicon.

The market as a whole- all individuals represent the health care consumers. It is a resource, we are consuming it. We are using it in ways that it does not regenerate. It's an economic term, not predator and prey.

My theory is that when the business folks got into managing health care they didn't bother changing out the words from the time they worked with services and widgets, and the medical folks adapted their lingo (incorrectly) instead.

If you were talking about cars it would be the same thing- we all count in the consumer market, but if you go to the dealer, you are a buyer (or potential buyer).

I consider myself a patient when I go to the doctor- it requires a heck of a lot of patience to wait around and have various people pop into the room while sitting in a paper gown. I would have no problem if my psychiatrist were to refer to me as a patient, though I have no idea what jargon he does use (when does this come up, anyway?). The only reason I would think that it may be a 'client' relationship, is that, unlike other physicians he is always on time and professional.

shraddha said...

This discussion TOTALLY rocks!

I totally agree with anonymous!

Actually this difference in ideology can be seen in the local hospital ads in our area.

The med centre advertisement boasts about having the best doctors in the area and being best in the research( in the country)

Where as Alegent advertisement, totally focuses on consumerism.
The CEO walks in (like in the sprint ad) and says 'we focus on total package'
Then they show a cancer patient...he says not only this person will get the value of getting her very small tumor detected by the best technology,also she the chance to be in a research study which only few have benefitted from but also shows how she will benefit from a social worker, a beautician who will get her the coolest wig after the chemotherapy.
Alegent's 'my cost' puts the costs right on the website for 'consumers' to see.

i guess its obvious the two groups are being administrated by totally different ideologys!


Battle Weary said...

I agree with the last anonymous commentor, 100%. I was working in the "business" end (billing/coding) when the changes started taking place. Doctors became providers, patients became clients and consumers, HICFA's became insurance payment requisitions, and patient statements became client account notifications. Okay...I'm kidding on the last two, but it was almost that bad.

The term provider has stuck in my vocabulary, but only if I am referring to a group. My GP is in a nine provider doctors, and two nurse practitioners. I realy, really dislike the client/consumer terms though. Basically, in my opinion, if a person has the title "Doctor", then that person has/sees patients. If the title is something else, then they have clients. The exception in my opinion would be RN's, respiratory therapists, etc...these people also have patients and not clients.

Doc said...

In a "residential environment" here in Virginia, we have moved beyond patients, clients, and consumers. The PC for our doctors and staff referring to (formerly known as) patients is "individuals." A word so PC-diluted, that it's meaningless. We're also removing the word mental retardation from all state verbiage- necessitating a change in the name of the state department of mental health. The new words are persons with "intellectual disabilities." This is also nondescript close to the point of meaningless. I find it interesting that the words "mental retardation," were themselves politically correct changes from old descriptors, such as "idiot."
George Carlin should be mandatory reading- "There are no bad words, just bad intentions."

Anonymous said...

I enjoyed your comments, doc, and agree. In my teacher ed program we were told that "mental retardation" is no longer used as a term, and instead, the (formerly labeled) mentally retarded are among the "exceptional students". I find that confusing because I always equated "exceptional" with being better than average, not worse. The term "intellectual disability" is the other term in use for under 70 IQ combined with adaptive behavioral problems. The subdivisions are now based on the amount of support needed: Intermittent, Limited, Extensive, Pervasive.

Anonymous said...

I think the last anonomyous is correct. A consumer is an economic description of what might otherwise be thought of as a patient. The use of the word client/customer is quite similar.

Probably the "consumer" phrase is better used when speaking of them in the aggregate. Individually in relationship to the Therapist they are Patients.

Since they represent your stream of income it's not a bad idea to consider them as economic beings either.

Your treatment of them as customers could also influence whether they hang around with you providing continued income, or move onto to someone else who has better parking or returns their call more efficiently.

The Shrink said...

I've heard of clients, users, service users, substance misusers, survivors but I favour the term patients.

Recipients of healthcare are patients.

My patients have had 3 surveys now, they wish to be called patients.

Two carer groups have had surveys, they favour the term patients.

With psychiatry being marginalised and mental illness enduring stigma, why don't we use the term patients, just as physicians or others would?

A pregnant woman going to her obsterician is not ill, but when I worked in Obs & Gynae the term for her was still patient.
A diabetic kid who's stable and having routine check up for microalbumin, retinal screening etc is asymptomatic and well but has a lifelong propensity for instability and shortened life (like major mental illness, then) but is called a patient.
An asthmatic bloke having a review of metred dose inhalers he uses is well but needs this medication ongterm to keep well (like many mental illnesses) and he's called a patient.

Why in mental health do we add more stigma with curiously unique terms?

Fat Doctor said...

I think the consumer thing is pervasive in all areas of healthcare, not just psychiatry.

We are inundated with survey results that tells us how our "patients" (or whatever you call them) feel about everthing from when we make our rounds to whether we wear white coats to how we address them (first name or Mr./Ms.).

It seems to me we are expected to alter our behavior according to these survey results.

Whatever. In two weeks, the survey results will change. I'm just gonna keep doing my job. The suits can refer to my patients as Martians for all I care.

Anonymous said...

I really hate "patient." It seems illness promoting, and since, especially in mental health, so much of the work is breaking sick roles and so on, I definitely don't want to be a patient. It implies lack of health, and often in psychiatry, paternalism.

Anonymous said...

I'm an LCSW and I always struggle with using the word "patinet" vs. client. I fell like the word "patient" is for doctor's....

shraddha said...

Where did the shrink rappers disappear?
It feels like an eerie silence after a train wreck.


antiSWer said...

I'm always confuddled by the word of the day and never pay much attention to what I use. As a social work student, that often gets me in trouble.

The argument I've heard against "client" and "patient" is concerning the roots of the word.

The roots of client touch on "leaning on" another, dependency and following and obeying. It seems as though we're trying to work towards a "working alongside" approach and this goes against that.

As for patient, roots are around "suffering or sick" person. With the strengths perspective of social work, this is a focus on the negative, not the positive.

All of these words may or may not have negative connotations...however, they're just words. What you say is NOT as important as how you treat someone.

Anonymous said...

I loved this. As a longstanding patient/client/consumer (consumer?!) of the mental health industry who goes back and forth on whether or not she prefers client or patient, this post gave me a good laugh.

I think part of the difficulty with the semantics of patient/client is that for so many of us, it's so awful to concede that mental illness is an illness that affects us...particularly when we are well, coherent, and functional.

But I will smile the next time I see my psychiatrist and picture her as a lobster. ;)

Mary said...

The only term that exceeds my loathing of the word consumer instead of patient or client is my hot white fury about the phrase "behavioral health" for psychiatric care or mental health treatment.

Psychiatric illnesses are not "behaviors" any more than brain tumors are. Mood disorders are not behaviors to be disciplined. Thought disorders are not "behaviors" to be punished. Descartes' mind body split simply not true.

Our peer support specialists all seem to LOVE being called consumers, but to me it is insulting and designed to destroy any parity that might form.

I do understand why many people want "people first" language despite its bulkiness, although I personally don't care, having been asthmatic all my life. My DH reminded me that it is the same issue as the "gender neutral" He that I oppose as not actually inclusive.

Anonymous said...

Political Correctness is good if we are talking about not saying really degrading things about people such as a fattie, or
a stupid idiot in referring to someone else. But, consumer, client, patient...
Jeez, they need to just pick one and stick to it. It doesn't offend me at all being called a patient. I am a patient of my pcp, and when I had a psychiatrist, I was a patient then too. Do patients really get offended if you call them a patient? I would rather be called a patient then a consumer. Something about being called a consumer in psych. treatment or therapy just doesn't seem quite right.