PATIENTS: Sufferers, Consumers or Something In Between?

The word we use to describe those who come to see us in person, or seek our advice through other means of communication, is ancient and – according to some – outdated.

Patient, both as a noun and an adjective, is derived from the Latin pati, which is a word for suffering.

Not long ago, people only sought a doctor’s advice when they were feeling ill. Now, more and more, we are involved in health promotion and disease prevention. In this new role, we need to think of our relationship with those we work for as something very different and more equal. We now speak of active patient involvement and patient participation and some people call that an oxymoron. I don’t agree.

No existing or new word has replaced patient. Consumer, client, participant, partner and many others have failed to get traction.

As much as I love words and enjoy learning or contemplating their historical origins, my own thought is this:

We don’t need a new word to replace patients. Words are just words, approximations. Changing our nomenclature for ethnic minorities did not eliminate the injustices of our society, as today’s news reports have illustrated, for example.

We need to work on our view of and relationship with our patients. Retailers have consumers, lawyers have clients, teachers have students. All those relationships are continually evolving to some degree, just like the doctor-patient relationship. Keeping the word patient and staying focused on understanding what they need from us helps us avoid the trap of commercializing or trivializing our relationship the way consumers would, for example.

Old and antiquated words can still make sense when describing something new and very different: You may be driving a combustion engine automobile in the US or motor car in Great Britain, or an electric car on the European continent, measuring its efficiency in miles per gallon, liters per kilometer or Watt hours per kilometer. But we all still like to think of our vehicle’s horse power, even though we know there are no horses under the hood and who knows what hundreds of horses could really accomplish if you tried to get them to pull a vehicle. They certainly could not match the speed or acceleration we associate with horse power numbers.

Patients of today are both looking to be fixed and seeking guidance on avoiding becoming ill. Some are even coming to us seeking health. Health is more than the absence of illness, but that is not part of the everyday thinking of most doctors.

This brings me to the question of how we want to define our own role in our chosen field: If a patient today is different from a patient a hundred years ago, how well has health care adapted to that evolution? I know drug companies are very much stuck in the old model of fixing suffering by external means. They promote the notion of artificial interventions creating active, smiling but still overweight diabetics with better blood sugar control, for example. That is not quite health or even the absence of disease, only the mitigation of some of the worst effects of illness.

Health care has largely failed to meet the needs of those patients who look for real health, beyond the absence of overt disease. That arena is now dominated by what we call alternative medicine practitioners. The Functional Medicine movement promises to bridge this gap, and maybe the medical school curriculum of the future will prepare doctors differently. But knowing how long it takes for even basic medical knowledge to change physician behavior, we will continue to muddle along the way we are for a while.

My only hope for the immediate future is that doctors, on an individual level, listen more to each patient we meet. If we acknowledge or awaken the desire for more than mitigating symptoms in some of them, it will rejuvenate us professionally and inspire us to consider the basics of health we have perhaps viewed as too trivial to bother with: nutrition, sleep, physical activity, relationships, spirituality in any of its forms, connection with the natural world. That includes respecting and listening to our own bodies.

Sure, diagnosing that insulinoma I think I saw the other day makes me a good traditional doctor for a traditional, helpless patient. But what about the handful of people who realized that the dietary changes they started to make made them feel better very quickly? They weren’t really suffering from anything serious and I didn’t really treat them in the traditional sense. But our engagement, or partnership, was just as satisfying as chasing down a rare diagnosis.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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