As time harvests the years and winnows my memories, I find I no longer sift through dictionaries looking for new and unusual words. The thrill of finding one is still there I suppose, but more often the discovery is in an interesting book or magazine and it is not so much the originality of the word as the novelty of its use -its evolution. And Medicine, as always, is rife with examples.

Of course some words needed to change completely and not merely evolve: Mongolism, for example, or maybe Venereal Disease. Anything that unfairly stigmatizes a person with the condition is appropriate for renewal -although I’m still puzzled about why Venereal is more offensive than Sexually Transmitted. Or for that matter, died than passed on. But I do not argue against euphemisms -they involve literal changes of words, new descriptions that better serve the currents of contemporary culture. I may not understand the reasons for the change, but eventually get used to them as accepted colloquy.

Some changes, however, are more difficult for me. The use of the word client instead of patient, for example, I find particularly vexing. I suppose this shows my age and era, but I still think of client as very much akin to customer –someone to whom one sells a product or a service. It implies qualitatively different expectations and relationship than would be present between, say, a store owner and someone who walks in the door to buy something. One expects service, yes, but relationship, no -or at least not the type of relationship necessary for the entrustment of life or limb: a personal, almost intimate relationship of belief, hope, and of course fear.

A comparison frequently utilized is with a lawyer; you become the client of a lawyer for advice and for assistance in matters pertaining to the law -neither requiring a particularly intimate relationship to accomplish. There needs to be trust, yes, but surely of a different type and magnitude than what is necessary to let another person -a stranger, by and large- tinker with your body, your health and your temple.

I know there is an argument that even to label someone a patient implies a power relationship and one that doesn’t admit of equality or sometimes even the ability to adjudicate the opinion sought and in particular the advice given. It is one-sided, and by and large non-negotiable. Client however, almost by default, purports to correct these defects by distancing the seeker and the giver by a more commercially understood transaction. The person signs a contract after an initial discussion, and both parties are thereby bound to whatever the agreement stipulates. I will  give you some money and you will give me a car, say. If you don’t, I understand that I can take action against you according to the terms of the contract that has not been fulfilled. In the case of a lawyer, it might be his advice; for a product, there is a warranty.

Ah, but there is one of the similarities with a doctor, you might say: I can sue him if he makes a mistake. He is for my health, what a lawyer is for the law. But if that is the basis for the use of the term client versus patient we had best be careful. The law is written and although open to different interpretations in some cases, is still the same law. Precedents may alter the way it is enforced, but it is still the Law and barring exceptional circumstances the outcome, with a little research perhaps, is usually determinable beforehand. The job of the lawyer is to apprise you of this beforehand and in some cases seek to alter the interpretation in your favour.

At first glance, this may seem similar to how the doctor operates: an investigation is conducted, a diagnosis obtained, and a treatment proposed -as with the law, all very logical and contingent. Except that a biological system is not subject to the same type of law as is a country. It is inherently variable, predictable only statistically; and even then, the context is different because of genetics, environment and personal choice of life-style. A person may have a heart disease -a heart attack, say- but so many factors may have contributed and continue to contribute to the problem that the necessary treatment will vary accordingly. And the outcome will vary as well. Underlying diabetes, smoking, blood pressure and obesity to name only a few, will continue to play a role in the outcome.

Like it or not, the person with the heart attack, is entering into a unique relationship with the “authority figure” -one that I suspect is entirely distinct from that with a lawyer, or a social worker, or a cosmetician… Or a teacher. Those with whom teachers interact, are pupils; the word is unique and the relationship recognizable. It does not denote inferiority or pejority any more than the word patient should. A pupil is a distinct, if evanescent, entity and so is a patient. Neither is intended as a permanent name, or an all-encompassing descriptive; it is merely an attempt to uniquely characterize a temporary relationship -one that admits of little need for further definition. For each there is a temporary abdication of personal power in exchange for something more important at the time.

I do not think of it as surrender of rights but rather a yielding of perspective, an exchange of fear and despair for hope and anticipation. It is a positive word that best describes a distinct alliance in a time of need and I, for one, will continue to use it.


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