My Twitter timeline has again sported a discussion on whether patients are patients, or perhaps service users or something yet different. I must admit that I find such discussions quite moot. But I would like to suggest a bit of linguistic realism, so that the discussions might become a bit more useful.
Before I offer the linguistic perspective, I want to explain why I find the discussions somewhat irritating. It’s because it is very unlikely that those who want to be patients will agree with those who want to be consumers, while all those will not agree with people who decided that it is ‘service users’ that describe their true nature. And if, say, I want to be a consumer, I can’t care less about the fact that most people prefer the ‘patient’ label.
The second reason why I find those discussion irritating is the arguments that it is the arguer’s preferred label that reflects the true nature of things. And as I assume that linguistics has something fairly sensible to say about language, I tend to think that such arguments are nonsense. There isn’t and there cannot be a label that reflects the ‘true nature’ of anything. Each label carries a host of ideological assumptions and people choose those labels because of those assumptions, regardless of whether they are aware of those assumptions or not.
And so, finally, as arguments about ideological perspectives, especially those we are fairly unaware of, are likely to remain unresolved, it’s considerably better not to discuss them. It saves breath and time.
However, I also think it is very unlikely that the above words will be heeded, so I have decided to offer a few comments to make such discussions slightly more fruitful, at least insofar as what is actually discussed. I offer my comments having despaired about such a mix of arguments that one would be forgiven for thinking that they were not part of one and the same debate. So, here is my crash course in debating healthcare (participant) labels.
The way I see it, the main problem in such debates is that the discussants ignore the fact that they are not discussing dictionary entries, but they are supposed to be discussing the way ‘we’ communicate. By ‘we’, I understand here a host of communicators, and in particular healthcare professionals and those in their care. I think there are three main contexts in which labels should be discussed.
1. First, and probably, the simplest, is the discussion about words referring to a group of people receiving healthcare. Just like we refer to doctors or nurses, we (probably) must have a way to refer to those on the side of the stethoscope.
Unfortunately, the complication is that I might not want to identify myself in the same way as those referring to me do. In other words, while the NHS might want to call me a patient, I might not. For I might want to be a service user, for example.
Important as such a discussion might be, there is not much point in suggesting that people should be called by their names. This is not the level at which one considers names, as we talk about (social) groups. In the same way, it’s not particularly useful to say that we need to call healthcare recipients people. Yes, people do treat people, but, that’s really hardly illuminating.
Incidentally, having seen some research on patients’ preferences (people tend to prefer ‘patient’), I’m not entirely certain how useful it is. Yes, researchers or organisations can go by majority preferences, yet, it still leaves the minority who will not be referred to as they wish. My own personal view is that life is way too short to be bothered by it. In contrast to oft made statements, I think label change is extremely unlikely to bring out change in practice. I accept, however, that for some people it is considerably more important than it is for me.
The discussion about references to the group of healthcare recipients can of course be nuanced. It is unclear for me, for example, that there should be consistency between, for example, academic/research literature and NICE documents. And, in my view, if someone does think that discussions about participant labels are important, they must consider their use in a variety of contexts. They also should, I think, consider various opinions. It’s hardly enough to say – I want to be a patient, therefore everybody should be called so.
Let me then conclude this part by saying that no matter what we do, we shall never ever achieve full consistency, let alone full satisfaction. There will always be those who will want to be called something else. And this is precisely why I don’t think such discussions are particularly fruitful.
2. The second context invoked by discussions is that of clinical interaction. This gets a bit more complicated.
The first issue is how to address each other (I wrote forms of clinical address here). I think it’s fair to say that the issues I wrote about above don’t apply here. It is unlikely that I will be called ‘patient’ by my GP, like in “Hello, patient.”. But before we dismiss it as impossible and not worth our attention, I would like you to consider that I can still say “Hello, doctor.”. Yes, there is a number of reasons why that is, but I want you to consider it because just in those two words, used as a greeting, the patient starts constructing (or co-constructing) asymmetry in the doctor-patient relationship. And if the doctor, as they often do, responds with “Hello, Dariusz” the construction of asymmetry is complete.
But, let’s move to the argument that people should be called by their name. The simplicity of such a statement is very attractive, but it’s illusory. What exactly do you mean by that? Do you mean that my GP should call me by my first name or by my family name? If by my first name goes, should it be ‘Dariusz’ or the more familiar and friendlier ‘Darek’? And that’s not all – should my GP call me Mr Galasinski, Dr Galasinski, or perhaps Professor Galasinski? And I don’t think there are easy answers to those questions. Moreover, it’s hardly helpful to say that the medic should follow my preferences. This is because my preferences are far from clear.
I do think, however, that doctors calling their patients by their first names take liberties and the only way to preserve a bastion of symmetry is when I call you by your family name and you reciprocate. Of course, I realise that I am still likely to call you using your professional title, still it’s better than nothing. Incidentally, over the years, I have tried to call doctors I saw using “Mr” or “Mrs”, or ‘Ms’, and both doctors and, in particular, receptionists balked at that. I was immediately corrected. That in itself suggests how important forms of address are.
The second issue is how you refer to me. It’s not particularly difficult to imagine that the doctor I see asks me, for example, ‘Are you Dr Smith’s….?’. So, what should the medic say? It’s easy to imagine ‘patient’, with some difficulty, but I can see ‘client’. I’m afraid I think ‘Dr Smith’s consumer’ is a bit too ambivalent, while ‘Dr Smith’s service user’ is probably impossible.
You could, of course, as was suggested by a discussant, suggest a more descriptive phrase, such as ‘Are you being supported by Dr Smith?’. Attractive as they might seem, however, also such phrases have their consequences. Not only is ‘supported by’ quite ambivalent and potentially wide-ranging, but it also places me, the patient, only as a recipient of doctors’ actions . And I think there is considerably more to my patienthood than being supported.
You could, however, avoid the problematic label in a such a context and ask me ‘Do you normally see Dr Smith?’, but this post is about labels, so I’m afraid this strategy is not particularly helpful here.
It’s worth adding, perhaps, that relationships evolve and, over time, the way we address each other may well change. But as we negotiate the way we address each other, I would ask doctors to pause before they decide that matiness is the way to go. Formality, including that in doctor-patient interactions has its uses and, perhaps paradoxically, I’d suggest it’s formality which is more protective of the patient. Matiness is more dangerous, as it might be imposed and reciprocated much less willingly than might be thought.
3. The last context to be considered is references to me when I am absent. In other words, how should doctors and other healthcare people refer to me when I am not present. Fortunately, or not, perhaps, I don’t care. As much as I do occasionally refer to the doctors I see as idiots, I see no reason why they shouldn’t pay me back. And no, arguments about respect etc. don’t really convince me. Just as I get irritated, angry, upset, so can medics, and they are free to call me all the names they want.
I do accept, however, that my attitude may not be particularly popular and others might care about this a lot. Still, I don’t think there is a way to police how people, including doctors, speak to each other.
And so, here is my crash guide in the issues raised by labelling discussions. I hope that I have managed to get across the message that things are way more complex than saying: I think it should be ‘label’. But when we engage in another one, it’d perhaps be useful to consider not only the labels you like or dislike, but also the contexts in which they will be used. Yet, I would also like to suggest that such discussions are considerably less important than they appear. And the doctor you dislike, disrespect and fear can very easily start using the label you love, but you will still dislike, disrespect and fear her/him. Language does matter, but there are things that matter considerably more. It’s always worth keeping it in mind.