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"Patient or Client"

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Now a days staff and other team members started using the word “clients” instead of patient (latest is “service user”. in future may be customer or share holder).already we are scared about getting sued by patients because medicine is becoming commercial and that is leading to growing gap between doctors and patients. If we started using these industrial names, in my opinion it increases the gap between doctor and patient. What do you think please post your opinions.

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I absolutely agree.

1. The word 'client' implies a contract. Unless these patients are directly contracted between a doctor and themselves, the client/provider relationship is between the management of the organisation.

- it is an attempt to rebrand liability for inadequate service provision and to point the finger at doctors. After all - the provider of the invariably inadeuqate service (e.g., lack of psychology service, no social worker, no OT, etc., etc., ) is now the doctor and not management

- the client has a contract with the service provider. In the US, the 'service provider' is the new brand for doctors. Again it displaces administrative liability to clinical liability

2. As long as practice is determined by clinical judgement, these patients are not clients in your eyes. Remember - you are an employee and basically a contracted client of the service provider (the trust/agency). You do not accept direct fees nor do you agree any legal contract with patients in A/E.

- The *hospital* forms contract with the patients who need a service.

- you are employed by the hospital for skills which the contract maker (the hospital) lacks by nature

- you are not the hospital

3. Management always refer to everyone in as dehumanised terms as possible

- this allows risk to human patients to be discussed without the blood and guts personal detail of actually accepting that such and such a lady who died because of lack of facilitites was actually a person

4. The rebranding is widespread and is not new. It's been evident in civil service organisations since before the 1960s. I think it's an attempt to appear better educated than you are really by having broad encompassing phrases that are more adminstratively digestible

- killing a patient sounds aweful

- killing a client is less so

- curtailment of a service recipient is even better

(you get the idea)

My advice is to make it a point in all case conferences, meetings, etc., to stress the DOCTOR and PATIENT as much as possible, stress the essential relationship, etc., as it's okay for management and such to step back but your duty to recognise patients as patients and not as 'entities' of the system.

If a doctor uses the term client it should only be in direct private practice as in that situtation, indeed, you are the service provider.

Remember that patients in public hospitals, etc., are clients of the management but patients of the doctors. There is no 'contract' between the doctors and patients save for clinical contract to give the best care and that contract is provided for by the medical council.

ANy one else got an opinion? I'd love to hear the reasoning behind the term being used in clinical practice as no, it's not 'stigma reducing' which is a reason given I've heard.

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When I heard the term,client being used in place of patient,I felt very angry.A floridly psychotic patient who was basically all over the place still managed to complain to me that he objects to be refered as a client by the nursing staff.I can understand the use of this term by the professionals like social workers,OTs,physiotherapists etc but find it absolutely absurd when doctors or nurses use this.

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I felt depressed, when a clinical **********r used the word clients.

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I have no clients or service users, I have patients. I am a doctor and I have patients. When I see my GP I wish to be a patient NOT a client. I would be interested to know if there is anyone who is reading this who would prefer to be considered as a client when they visit a doctor.

The other REALLY important issue comes from psychotherapy- one of the most intrinsic and important features of psychotherapy (and all our clinical work) is the doctor-patient RELATIONSHIP. One does not have a relationship with a client.

I can say hand on heart that I hope I will never have a client in the whole of my working life; if that day comes it would mean I have become a people processor.

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Hmmm. Very interesting!

I think it should be left to the patients to decide what they want......

...and why are we presuming that there is no relationship between a service user and a service provider? :-/

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whats in a name?

I am curious to know who came up with this idea of a change in name..what is the political correctness of it?

from where i come, the terms doctor and patient have been invogue for ages.I doubt if anybody there, is willing or wanting a change there.Just like having a ICD or DSM makes things easier,so would terms in each society.so why come up with 'client' or service user?did anybody find it offensive to be called as patien?..i am curious.

having said that...what is my problem if i were to address the person in front of me, as a 'client'/service user/ or whatever neologisms thrown in.I dont have a problem.I treat/provide service as before.If he objects to be called as patient, then address him as he wishes.

20 years down the line, if again some genius likes to change the accepted client to patient...how would the future generation react?..i am curious

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I think using client is a disgrace, may be when NHS turns Messrs NHS.inc...with trusts having shares....

personally i think to refer anyone by their name is the best, 'patient' is undeniable while service user must be only at teh discretion of the patient.

cheers

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I want to remind friends that here on this forum we are not talking to our consultants or managers. We are expressing our feelings/thoughts. so be bold and post your feelings.

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I hate the client thing too...

I think it may have come about (and I'm NOT making excuses for it) as a result of having social workers in our CMHT's. Obviously being non-medical they have 'clients' because they can't have 'patients'. But now we all work in one big, happy (!) team and the term has spread. (just guessing)

I agree we have to continue to have patients. It is more than just a name. I think increasingly nurses and social workers are doing our job in terms of assessing patients, in CMHT's team members are basically doing the same thing whether from a nursing, social work or OT background. I have nothing against these professionals, in fact I think all of us from whatever backgroung need to do what we do best, and not be reduced to a mental health 'practitioner'.

Perhaps someone could do a survey of 'service users' views on this?!

(Sorry, too much caffeine today!)

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its patients for me...cant think of my interactions with a patient as a 'business' to call them clients.

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I find the term service user a bit more acceptable than the term client which i hate. Dont know where all this political correctness is going to take us.

one day we all will be called service providers and not doctors.

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So the solution is to start referring to the service as the service provider. The NHS hospital = the service provider. I suggest everyone start using this in presentations to pre-empt rebranding of the speciality.

Service provider is a description, doctor is what you do.

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i personally feel very strongly about this whole business of service provider and clients

why cant we carry on being patients and doctors...

i mean arent we digging our own graves... first we agree to all these stupid trends .... allow ourselves to become medical social workers and then complain that the doctors on the general side dont respect us!! :-/

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why would A&E SHOs or for that matter medical/surgical SHOs treat us like doctors when we refuse to defend our identities as doctors...

in the name of MDT working we are allowing a blurring of boundaries between nurses, social workers, OTs and ourselves.

no one takes us seriously anymore...

(i know i sound nihilistic, but then how else would i feel when in my MDT i see a newly qualified pharmacist commenting on the psychopathology of a 'client' and 'suggesting' blood investigations)

I AM SHATTERED

IF THIS IS WHAT I SIGNED FOR.... THEN I WANT OUT!! :'(

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Thats interesting.I have a very efficient pharmacist in my hospital who also likes to speak to the patients during ward rounds,not only about drugs but could be any thing,ranging from social issues to psychopathology.

I must confess that when I encountered MDT style of working in this country,felt threatened.Well afterall its my job and my pride to be messiah for my patients.Somehow after 3 years of working with other proffessionals who are as eager to deliever as most of us are,I now feel no more threatened,because at the end of the day(ward rounds etc) its me whose verdict is the final verdict.However I have to work hard,thinking on my feet,good communicator,good negotiator and to do all the effort to take every body on board.Believe you me it not only improves the quality of care for my patients but also increases my own self esteem and helps me to earn the respect of MDT members.

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It is always patient for me. There is no stigma attached to it. Pregnant woman coming to AN appointment is a patient though she is not sick or ill. Man coming to get a seb. cyst removed is also a patient.

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dear khuram

i couldnt agree more with u regarding the usefulness of MDTs.... i am not against well meant advice and i am always up for suggestions for the betterment of patient care...

what piss*s me off is the fact that the Members dont just suggest... they command.... there are sullen faces and talks about consultants being Narcissists if they dont agree with the psychopathology as described by a pharmacist or a nurse...

incidentaly in their brand of 'sims psychopathology' a patient is either 'thought disordered' or a 'PD'

GOD SAVE US ALL

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You are right Dr.Puri. Few days ago during our ward rounds one student nurse gave her valuable opinion on one of our patients. She said patient(actually client) is thought disordered. I asked her after ward rounds what she meant by thought disorder, she said patient was manipulating….. God save our profession. I will not be surprised if that student nurse becomes CMU manager in the future and tells me how to deal with patients.

NB:in case notes we(stupid 'I') documented under staff report: that patient is still thought disordered .

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NB:in case notes we(stupid 'I') documented under staff report: that patient is still thought disordered .

WHy? Dude, I would counteract that crap live in front of everyone. Until you start acting like you are the authority, you won't get it.

Maybe I'm a jerk, but if I hear some uneducated nonsense like that (and it happens a lot) I smack that shit back down. If I was a cardiothoracic surgeon I wouldn't take a student nurses opinion on whether that was an anterior descending I was going to cut or not.

Likewise, I don't think anyone psychiatrist should take the opinion of misinterpreted grammar to equal an understanding of psychopathology.

It's an easy misunderstanding that the words we use are just made up. People thinks it's straightforward because it's in English and hey we all speak it everyday.

Part of my solution is to start using the german psychopathology terms which are just as valid and have a longstanding basis medically and legally.

Opinions are like assholes - but you need to make sure you are the biggest one because otherwise everyone gets to be an expert and IT DOESN'T HELP THE PATIENTS.

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'WHy? Dude, I would counteract that crap live in front of everyone. Until you start acting like you are the authority, you won't get it.'

Because, patient really has thought disorder .but according to student nurse thought disorder means manipulation.

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