This argument, too, cuts little ice. The basic notion to me is trying to see through the eyes of the patient and understanding patients expectations, perceptions and experiences, rather than just seeing through our professional eyes. Just make them welcome, put a smile on your face, and remember that when they come in through the door theyre poorly, theyve found out somethings wrong, and as far as theyre concerned, theres only one person in that hospital thats them (nurse). What about customer? But user is hardly a felicitous expression. Let us suppose that the continuing use of patient were having a detrimental effect on the attitudes of doctors and nurses to people who come to them for help, what word would we put in its place?

Journal of Family Practice; 49: 9, 796804. Theres no relationship in a customer (nurse). We turned to the policy literature to examine what politicians have set out to achieve in relation to patients experience, and how they have framed the terms of the debate for their purposes over the past 20 years. For patients organisations and consumer groups, patient-centred usually means: services that listen to patients, take their views seriously and attend to aspects of care such as dignity and respect for individuals; well-organised care; clean wards; and nutritious food. It does not make me want to get out of bed every morning because I want to be more patient-centred (manager). For The Point of Care programme, we adopted the IoMs (2001) definition because it is the most comprehensive, and is based on the work of the Picker Institute, a charity that studies patients experiences. The words that resonate with people at all levels seem to be theordinary, human words for care mentioned in the last section, rather than management speak and policy jargon, which can be seen as imposed on the hospital from outside. In short, the word sits ill with the modern idea of the patient as consumer, as an equal partner with her doctor, nurse, or therapist. Health seeker would focus on the promotion of health as opposed to the mere sorting out of sickness, but it would be more than a little absurd.

Words acquire new meanings through custom and usage, and the extensive use of the word in its clinical context has secured its new meaning. Our aims were to explore: the terms and concepts people use to talk about patients experience; how the language and terminology varies between groups; and how people feel about current policy language (Wood, 2008). Given the imprecise use of language uncovered so far, we decided to try to find out what language we should use when working with hospital staff. The active patient is a contradiction in terms, but the confident service user, informed and participative, is someone one might hope to see in most healthcare settings. The word patient conjures up a vision of quiet suffering, of someone lying patiently in a bed waiting for the doctor to come by and give of his or her skill, and of an unequal relationship between the user of healthcare services and the provider. Able to withstand or endure an adverse environmental condition: The definition of an inmate is a person who is confined to an institution such as a prison or mental hospital. To investigate reactions to the concept of patient-centred care and the sound-alike concepts, the research asked participants to respond to the following words and phrases shown to them on prompt cards: Without exception, all the words and phrases provoked either mixed or negative reactions.

Empathy and compassion would be seen as threats to productivity after all, they take time, dont they?

Strategy documents and policies began increasingly to refer to the ambition to create a patient-centred NHS. By NT Contributor, The language that hospital staff use to describe patient care can differ from that found in research and policy documents, so terms must be chosen carefully. Yes!

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Other staff associated it with policies promoting choice or with mechanical care packages. Some nurses thought it was just buzz words, but others said it was the reason they had come into nursing. Many of the encounters between healthcare professionals and the public are not about healing as such, but about the activities of normal lifemaking choices about lifestyle, optional services we might want, or advice on matters such as fertility or cosmetic surgery. The aim of The Kings Funds The Point of Care programme is to improve patients experience of care in hospital, and to help staff deliver the sort of care they would like for themselves and their own families. PMC legacy view HHS Vulnerability Disclosure, Help Unable to endure irritation or opposition; intolerant: The definition of pertinacious is a determined person, or a person's stubborn hold onto their opinion. Makes me think of death and palliative care and old people and pain so if Ive got a rash and need cream for it, I dont need to be dealt with humanely, just nicely. Conclusion: It is important when working in a hospital context to use language that staff prefer. In these days of public involvement and active participation, has the term patient become an offensive anachronism or does it capture what is positive about the special relationship between health workers and ill people? Aim and method: We decided to carry out our own research to see what language staff working in hospitals preferred to use when describing their care of patients. Besides, if patient really were an offensive hangover from an age of authoritarian clinicians and cowed, passive patients, why has it retained unchallenged supremacy in the United States, the centre of consumerist medicine, where the patient is quite definitely a partner? sharing sensitive information, make sure youre on a federal To non-nurses, basic care meant the unpleasant bits of nursing or the bare minimum. Quality improvement was central to the reform and modernisation process, expressed as quality in its broadest sense with patient experience talked about alongside clinical outcomes (DH, 1997). Better to improve that practice so that the connotation of patient becomes wholly positive. The expression has come to mean an awful lot of different things, as its become shop talk. As a rule, people said they preferred ordinary, human words for care. The data was collected in 2008 in four acute trusts in England using a mix of focus groups and paired and single in-depth interviews with around 30 staff. They might have just wanted a hand with a wash, or giving them a towel, or just a chat! Patients experience, or patient-centred care, is seen as a key aspect of quality of care (Department of Health, 2008a; 2008b; 2008c).

Join Macmillan Dictionary on Twitter and Facebook for daily word facts, quizzes and language news. Youre just giving them something and theyre taking. Compassion, empathy and responsiveness to needs, values and expressed preferences, 3. The word patient does conjure up that sense of passivity, because that is its true meaning; the idea of active participation sits poorly with it.

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Delivered to your inbox! Social Science and Medicine; 51: 10871110. Patient. Merriam-Webster.com Thesaurus, Merriam-Webster, https://www.merriam-webster.com/thesaurus/patient. Bethesda, MD 20894, Web Policies An alternative might be client, yet client conjures up a quite different kind of relationship of purchaser and provider, often anything but the case, at least directly speaking. Joanna Goodrich, MA, is senior researcher, The Point of Care programme, The Kings Fund. Yet consumers of healthcare services are undoubtedly their users and their active recipients, rather than their passive accepters. All rights reserved. London: DH. Have you made the shortlist for the Nursing Times Awards for 2022? When looking at the terminology that policymakers use, it seems that different terms variations on patient-centred care have been favoured over the years. Younger doctors seemed to like it; older doctors and managers thought it a laudable but unrealistic objective for the NHS given current resource priorities and constraints. 2022. The distinctiveness of patient reminds us of the vulnerability of the ill person and the often harrowing responsibilities of the doctor or nurse; something frequently forgotten in the consumerist world picture. Nglish: Translation of patient for Spanish Speakers, Britannica English: Translation of patient for Arabic Speakers, Britannica.com: Encyclopedia article about patient. Yes, it is tainted etymologically. In short, words, like their speakers, move on. Free from anxiety, tension, or restlessness; composed: Patiently enduring wrongs or difficulties. One of them words thats been brought out to sound a bit more than it is. Institute of Medicines definition of the dimensions of patient-centred care, 1. It makes it sound like theres no care either way. The phrase seeing the person in the patient resonated positively with all participants: Yes, seeing the whole patient. Department of Health (1997) The New NHS: Modern, Dependable. Out of public scrutiny; known or discussed by few: (Electronics) Exhibiting no gain or contributing no energy: The definition of submissive is willing to do what others want. How to use a word that (literally) drives some pe Editor Emily Brewster clarifies the difference. Good care for them was not an abstract concept it was either an attitude or a narrative (see Box 3). Nearer to home, there have been terminological changes that have made a difference. Theyll be asking us to say Have a nice day next! (nurse). Patient-led services would ensure patients were treated with respect, dignity and compassion. A more obvious choice would be client. Social workers have clients, and this is a noble effort to correct the means test ethos that saw the benefits seeker as a supplicant. Stewart, M. et al (2000) The impact of patient-centered care on outcomes. about navigating our updated article layout. Box 1.

Finally, she will gratefully endure medical mishaps instead of having recourse to the courts, where (it is rumoured) justice is to be found. The minute that happens, words take on many different meanings.. If you think of your own mum, youll not go far wrong (care assistant). John Majors government set the pattern for what was to follow with the first aspirational vision for hospital patients set out in The Patients Charter (DH, 1991). The .gov means its official. Change takes time, effort, and resources. Department of Health (1991) The Patients Charter: Raising the Standard. The same is true of the term consumer, from the modern consumerist language that led to the term patient seeming curiously old fashioned as well as inaccurate. Department of Health (2005) Creating a Patient-led NHS: Delivering the NHS Improvement Plan. Background: During the planning phase of The Kings Funds The Point of Care programme, we undertook a literature review, starting with the term patient-centred care. The patient, in this language, is truly passivebearing whatever suffering is necessary and tolerating patiently the interventions of the outside expert. Dilemmas and Prospects. Support staff had not heard of it and thought it was meaningless. London: DH. Information, communication and education, 5. Careers, Department of Geriatric Medicine, Hope Hospital, Salford M6 8HD, The word has undesirable connotations which have a bad influence on doctors attitudes to the people who come to them for help and advice, There is an alternative word that would serve the denotative function of patient without carrying its putative adverse connotations. Reactions to patient-centred care were mixed. London: DH. Most recently, a strong policy strand has emerged that aims to improve patients overall experience. In the current NHS Operating Framework (DH, 2008c), improving patient experience is a top priority and hospitals will have to report on three aspects of quality: safety, efficiency and patient experience. Yes, once that person steps over the threshold theyre a different person its about understanding that theyre scared (support staff). But lawyers also have clients, and the use of this term in health care might capture the sense that doctors sometimes have of the patient as a prelitigant. Thus, the strongest argument against the use of patient to describe a user of health services is that word indicates immediately the unequal nature of the relationship and objectifies the person who is the user. Bikini, bourbon, and badminton were places first. Some of these terms can be found alongside each other in the same text, while others are favoured by a particular discipline. Shops have customers, but the implicit contract between a doctor and an ill person is totally different from that between a retailer and a shopper. government site. The customer demanding something is not the basis of good care (doctor). Think of the all the new verbal habits we would not have to learn, all the new stationery we would not have to buy, all the new signposts we would not have to erect, all the money and consciousness that could be saved for er patient care. We quickly discovered that we needed to extend the search to incorporate other similar or sound-alike terms including: family-centred; relationship-centred; person-centred; patient-led; personalised; individualised; patient experience; humanity; dignity; empathy; and compassion. Delbanco, T.L. Open University U205 Team (1985) Caring for Health. Milton Keynes: Open University Press. Aspirations included respect for privacy, dignity and religious and cultural beliefs and for every patient (eventually) to have a named nurse, midwife or health visitor. Terms are sometimes confused and used interchangeably sometimes in the same document. The healthcare professional is the healer, while the recipient of healthcare services is the healed, and does not need to take a part in any decision making or in any thinking about alternatives. In much the same vein, there were mixed but mainly hostile reactions to talking about patients as customers . Trust and compassion may stink of paternalism (or maternalism), but without them medicine stinks. an individual awaiting or under medical care and treatment, accepting pains or hardships calmly or without complaint, continuing despite difficulties, opposition, or discouragement, 'Dunderhead' and Other Nicer Ways to Say Stupid, 'Pride': The Word That Went From Vice to Strength. The definition of intolerant is someone who is unwilling to accept differences in opinions or other ideas, or someone who is unable to handle something. Six years later, the newly elected Labour government began a 10-year programme to reform the NHS. The change in terminology would bring about an improvement in attitudes. The language of policy documents and guidance is not precise. We therefore decided to take patient-centred as the starting point of a literature review that looked at evidence of efforts to improve patients care. In a late echo of The Patients Charter, it goes back to declaring patients rights and speaks of them being treated with compassion and respect. The active patient is a contradiction in terms, and it is the assumption underlying the passivity that is the most dangerous. A patient who is lodged and fed in a hospital, clinic, etc. She will comply with treatment rather than agree to it. They were drawn from a range of groups: junior doctors; qualified nurses; healthcare assistants; mixed support staff (ward domestic/porter/receptionist/ward clerk);allied healthcare professionals (therapists from different disciplines);consultants; trust non-executive directors; chairs of trusts; trust executives; and trust middle managers. Lord Darzi, the reports author, speaks of the vision for the NHS for the next 10 years, which involves four key elements an NHS that is fair, personal, effective and safe. I think caring is about more than just meeting the needs there are a lot of things youd like, as a patient, that are not just needs (senior doctor). Even if there were a case for change, and a satisfactory alternative, would there be any reason for thinking that this would drive improvements in doctors attitudes and behaviour? This implication, however, is not carried by the rather general term patient; we are used to the notion that we are patients at some times and not at others. A final point. Not a hospital word (support staff). The new PMC design is here!

Most linguistic reforms reflect rather than bring about changes in attitudes. (2005) Patient-centered care and communication: an expert interview with Tom Delbanco MD. I wince whenever people use the obsolete term epileptics to refer to people with epilepsy; it seems to imply that people are identical to their illness. The passive patient will do what he or she is told, and will then wait patiently to recover. But until we have any data, we should conclude that it is necessary to leave well alone. Department of Health (2008a) High Quality Care for All NHS Next Stage Review Final Report. Dorothy was surprised to find how patient the people were, for her own little heart was beating rapidly with excitement. The particular attraction of the definition is that it incorporates both the what of process and the how of relationship, attitudes and behaviours. Replacing patient with consumer might foster the notion of doctors and nurses as functionaries in a healthcare business whose product is as many litigation-free units of care in as short a time as possible.

Other people who work in hospitals or care for people who are ill, Doctors and other medical and health specialists, Rooms and departments in hospitals and clinics. Instituteof Medicine (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. To paraphrase Viscount Falklands well known maxim, if it is not necessary to change something, it is necessary not to change it. If the debate were worth pursuing, the next steps would be to research what people actually think about the word patient, what they think about the alternatives, and whether there is any evidence that terminological change of itself brings about alterations in the collective consciousness or whether it merely follows it. Accessibility A significant proportion of the evidence on patients experience of care, along with descriptive reports of interventions and promising practice, is published in non-peer-reviewed nursing, medical and management journals. The review commits to providing safe, personalised, clinically effective care and locally-led, patient-centred and clinically driven change. The term patient-led, closely related to the concept of choice, was used to describe services with particular values or attributes. British someone who looks after a person who is ill or unable to look after themselves. A health professionals view on the term patient-centred care, I never liked it [the term]. But there is another argument for removing the use of the word patient from the vocabulary of the relationship between the healthcare professional and user, the argument we all too often forget. I want to receive exclusive email updates from YourDictionary. In other groups, people said dignity was only part of the story: Theres a lot to care that is not encompassed by dignity like making sure theyve got food they like (doctor). The language of research and policy clearly does not translate well into the everyday language of staff in hospital. More specifically, we should be confident that: My case for retaining the term patient is based on my belief that none of the above points holds. First of all, what is wrong with the word as it stands? Discussion and research appear in what might broadly be termed medical humanities as well as clinical and social sciences disciplines. Todays relationship is one of equals, with the professional adviser giving his or her fellow citizen useful advice. and One definition had four criteria for the quality of health care: humanity, efficiency, effectiveness and equity (Open University U205 Team, 1985). (2009) Exploring the wide range of terminology used to describe care that focuses on the patient. There have been some attempts to define exactly what lies behind the term patient-centred in primary care (Mead and Bower, 2000; Stewart et al, 2000) and elsewhere. In social work, personalised care is used (particularly concerning the way a person can plan and pay for their own care), while family-centred care is used in the literature on childrens care. The definition has six properties or dimensions (see Box 2). The NHS Constitution (DH, 2008b) introduces new pledges. The tendency in policy, as in published research, has been to focus on one of the IoM dimensions of patient-centred care but not the experience as a whole. A daily challenge for crossword fanatics.

Learn a new word every day. Another had six criteria, of which two concerned patients relationship to care: acceptability, appropriateness, accessibility, equity, effectiveness and efficiency (Maxwell, 1992). So while the term patient may be steeped in the abuses of the past, is also captures what is positive about the special relationship between health workers and ill people. Available on request from pointofcare@kingsfund.org.uk. Results: It seemed the language hospital workers preferred to use was different again, and that staff (some groups more than others) did not like much of the language that academics and policymakers use. It offends everyone, because each health professional thinks he or she is patient-centred. Sign in or Register a new account to join the discussion. Privacy Policy. First, though, we needed to see how others had understood the concept, and that is the focus of this article.