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Psy01
I agree. What is the idea behind its use anyway? I never really heard a coherent explanation.
Psychologists who don't address themselves as "doctor."
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I agree. What is the idea behind its use anyway? I never really heard a coherent explanation.
I'm guessing that "consumer" came into use because it might promote the idea of both consumer rights and protection and the idea of having clients/patients and their families very actively involved in the design and delivery of services (not passive recipients). For example, peer case managers are "consumers" of mental health services themselves, but in recovery and trained to provide services, bringing expertise from their own experience with SMI and the treatment system. So I guess it was a consumer-provider continuum?
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Wow with regular guesses like that you'd get kicked out of most casinos...
"Consumer" was adopted because folks were tired of the "Take it or leave it -- oh wait, you can't leave it until we say you're better" model of clinical care. "Consumer" was adopted to remind patients they have wide discretion when signing up for clinical care, as well as a duty to perform due diligence, and should they come to decide they are dissatisfied they can shop around for something more to their liking.
Of course the more militant faction of the C/S/X movement (consumers, survivors and ex-patients of psychiatric services) has become critical of "consumerism" insofar as "consumers" are removed from the means of production -- they have indirect say-so in the design of the products that they browse and consume. With the motto, "Nothing about us, without us," this faction often (not always) rejects any suggestion that clinical specialists with advanced education and/or training need to be involved in the design and/or implementation of services.
I tend to agree. There are but rare exceptions when my colleagues or I refer to those people signed up for our services as "customers," never mind "consumers." I have always used "client" to refer to people coming to see me for services. "Client" hearkens to a more collaborative working relationship, along the lines of a design or legal consultancy.
And down the line, it need not preclude anybody reserving the term "doctor" for me. The question is, if someone (me included) wants to use that term, what power play is involved -- what expectations, demands and rules are being invoked (tacitly or explicitly)? What is the larger political/economic context? What alternatives are being anticipated/warded off? Exploring these questions seem to be as much a part of the services to come as anything else.
I hope that was coherent and not too off topic...
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Buzzword: I think you are right on topic and believe our "clinical" work is always best informed by a social psychology perspective. Thanks for the history and info on the C/S/X movement. While militant/fundamentalist positions (on any issue) are usually not the ones I adopt, I do think that the evolution of consumer/peer provider services has helped return community mental health work to it's original values in good ways and keeps pros on their toes in terms of not falling into derogatory clinical language or underutilizing the strengths of those who suffer (which is. I believe, the etiology of the word "patient")...I prefer "client" because I think it contains the idea that even if the person is suffering they also have the strength to make decisions about where the work is going and responsibility/credit for how the change they are hoping for will actually come to be in their life.
Just for the record, I do generally recommend people err on the side of going by formal titles when in doubt. Some may be offended by omission of the title, but I think few will be offended by including it.
That said, I think the need to be perceived as buddy-buddy might stem from the "business" side of undergraduate education, where the US differs markedly from the many European systems. People are probably more likely to continue paying 40 grand a year to go to school if they are "friends" with their teachers (not that I think this is a good thing...just that I think its reality). I do think the teacher evaluation system is kind of f'd up in a lot of places given I'm sure the best predictor of good evaluations is a high average.
That said, I think I just generally dislike formality. I don't understand the purpose of it, particularly when it encourages people to put on act. It is very unnatural for me, though I'm certain that is cultural. I prefer to command respect through my actions, and for other people to demonstrate their respect in useful ways, rather than what they call me. "Hey you" gets the job done just fine in my book.
That said, I'm still shocked that is sounds like many of you have had professors go by Dr. in grad school. Maybe I'm just in a laid back subfield? Even at conferences, almost everyone goes by first names, from the "legendary" senior scientists with millions upon millions of dollars in grant money on down to the newly minted PhDs. I've even had some of the biggest names in the field introduced to me by their seemingly-ridiculous nicknames.
That said, I think the need to be perceived as buddy-buddy might stem from the "business" side of undergraduate education, where the US differs markedly from the many European systems. People are probably more likely to continue paying 40 grand a year to go to school if they are "friends" with their teachers (not that I think this is a good thing...just that I think its reality). I do think the teacher evaluation system is kind of f'd up in a lot of places given I'm sure the best predictor of good evaluations is a high average.
That said, I think I just generally dislike formality. I don't understand the purpose of it, particularly when it encourages people to put on act. It is very unnatural for me, though I'm certain that is cultural. I prefer to command respect through my actions, and for other people to demonstrate their respect in useful ways, rather than what they call me. "Hey you" gets the job done just fine in my book.
That said, I'm still shocked that is sounds like many of you have had professors go by Dr. in grad school. Maybe I'm just in a laid back subfield? Even at conferences, almost everyone goes by first names, from the "legendary" senior scientists with millions upon millions of dollars in grant money on down to the newly minted PhDs. I've even had some of the biggest names in the field introduced to me by their seemingly-ridiculous nicknames.
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Yeah, I think that's another "cultural" thing. In my experience, physicians say "patient", psychotherapists say "client", and crisis workers say "consumer".
For me (a physician), I mostly say "patient", but sometimes say "client." I see them as pretty interchangeable. I have had physicians chastise me for saying client though. It undermines our prestige or something like that.For some reason, I dislike the word "consumer". It just seems to devalue the therapeutic relationship to me. Like psychotherapy is akin to going to the grocery store in search of the makin's for potato salad. Attorneys don't call their clients "consumers" and I don't think we should either. Plus I just don't like the sound of the word. It makes me visualize people running around consuming things. But that's just me.
It can depend on the place of work, too. I work at a hospital where everyone is "patient" whether it's a nurse, physician, lcsw, intern, etc. addressing them.
I work at a hospital with a fairly rigid heirarchy, so I get called just plain "doc" or "doctor" by both the staff and patients regularly, with the exception of the other physicians, social workers, and a good chunk of the nurses (first name basis).
Personally, I just find it sounds strange when I'm referred to as "doctor," although I've just started getting used to it after six years. I like "doc" (which is what the patients often call me) - it sounds like a term of endearment.
Lastly, when left to my own devices, I tend to use the term "client" or "consumer" myself when I describe the non-staff recipient of my services, although since I'm at the hospital they're all "patients" or "residents" anyways (I work at a nursing home).
Personally, I just find it sounds strange when I'm referred to as "doctor," although I've just started getting used to it after six years. I like "doc" (which is what the patients often call me) - it sounds like a term of endearment.
Lastly, when left to my own devices, I tend to use the term "client" or "consumer" myself when I describe the non-staff recipient of my services, although since I'm at the hospital they're all "patients" or "residents" anyways (I work at a nursing home).
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"Consumer" really bugs me, probably because it implies a transactional relationship. I would feel very odd calling a patient "consumer". In the VA setting it is easy because "Veteran" is the almost universal term. Sometimes "patient", but that is in the minority.
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Simply Brilliant! - it rolls off of the tongue like molasses.
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I prefer to use "patient" when referring to those on my therapy caseload mainly because I feel that the etymological foundation of the word (i.e. suffering person) captures the essence of healing nature of the relationship.
I feel that both the "client" and "consumer" labels unnecessarily commercializes the therapeutic relationship and can, in certain situations, unduly modify treatment expectations by infusing an unrealistic sense of therapeutic potential; for, as we all know, "the customer is always right".
However, in a consulting role and perhaps even in some evaluatory roles I feel comfortable referring to those who seek my services as "client" since, as I stated above, it better reflects the nature of the professional relationship.
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In regards to being called "doctor" - why the hell not? I firmly believe that as psychologists we worked very hard to attain our professional credentials and I think that maybe some of our collective misgivings with using this title - both professionally and socially - stems from some type of vestigal blind reverence to anything that walks around in a white lab coat.
Now I do not insist on being called "doctor" with my patients, especially after forming a therapeutic alliance; however when testifying in court, in multi-disciplinary staffing, or in other similar situations I do think it is important for us to be comfortable using this moniker.
I actually don't mind emphasizing the transactional aspect of the relationship. I have a product (my services) and they are consuming it - literally. I don't personally see why that rankles people so - but aesthetics are very personal, I suppose.
At the VA, yes, "veteran" is probably the default terminology in the various outpatient clinics and services out there. But on the inpatient side, I've found that "patient" is the default, and "resident" is actually the term Central Office wants us to use when speaking about LTC patients.
But again, my preferred terms are "client" and "consumer."
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Oddly, I've always preferred "resident" when working in an in-patient or residential setting, both of which seem to be longer term situations. I picked that up from the culture of each facility, though I think it works.
I believe there is a lot of power in the labels and terminology we wish to use in both personal and professional settings; it sets the tone for interactions and expectations. For instance, the tone and expectation of someone being called, "a schizophrenic" vs. "a person with schizophrenia" is quite different. I believe the former sets the expectation that the person is their disorder. It typically happens out of frustration...."borderlines drive me nuts!" is something I've heard quite a bit.
Everywhere I go I try and stay vigilant about seperating the person from the disorder. Some people have described "becoming" their disorder, and this only strengthens that believe. I saw it quite frequently when I worked with eating disorders, and I have also seen it in people dealing with schizophrenia and/or biploar. Words can be quite powerful, and I think it is important to remember that....whether it is with "Dr.", "Patient", or "Schizophrenic".
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When people with psychological problems of any kind get referred to as "clients" they unfortunately are allowing the provider who is choosing to do this to further the stigmatization of mental health at their expense. There is now a whole generation of medical providers who have experienced this trend toward the "client" and no longer see just a person who is getting needed help, but rather an assumed package of assumptions that include "crazy", "problematic", "don't want them as my patient", and even worse "psychosomatic and malingerer".
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to the first part The word "client" to me is merely is a synonym for "customer," which I'm comfortable with and in fact does not "further... stigmatization" in the minds of anyone I know (either mental health professionals or otherwise). I've been in this business for a few years now and I'm surprised that anyone would regard the use of the word "client" as negatively as you.
However, it's possible that within the social and linguistic context you practice within, the connotations of the term may be different. Such is the imprecise nature of language, I suppose.
Words and terms I tend to stay away from due to the labelling theory issues include "psychiatric patient," "schizophrenic," etc. - and outside of an actual hospital, I avoid "patient," period.
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Psy01
I agree as well. I recall when I first read about this idea of not using terms such as the above. My knee-jerk reaction was that this was more political correctness (that can be really irritating). But I reflected on it and agree completely, and have never again used terms like "schizophrenic" or "anorexic" or anything like that.
The way I think of it is to analogize it to physical illness. You would say "a person who has cancer." You wouldn't directly call the person "cancerous." So too should you say "a person who has schizophrenia" instead of "schizophrenic." The person should not be labeled as an illness.
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What does the term "patient" mean to you?
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Specific terminology also is informed by your model. I identify a lot with a recovery model, so my terminology needs to reflect that. It can be challenging to providers because we only see our patients in one context, and we often are confronted with maladaptive behavior related to their Dx, though they are much more than how they present while in our office.
I did not imply that the term client is affecting how mental health providers view the patient/client, but how it is profoundly affecting medical providers views. It says to them that the false dichotomy of medical/psych is in fact still prevalent. With all the efforts towards ridding ourself of this false distinction, and current movements towards integrated care at all levels of medicine I find this very troubling and a disservice to people with mental health needs. I am a medical/prescribing psychologist and work in primary care, hospitals and teach in a family medicine residency program in Wyoming.
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i dont get it. Doesn't "patient" do this too (ie., promote the automatic assumption of illness and/or pathology?) in many peoples minds?
" Are you meaning that the term client get's brushed off as an "in-their-head" sort of issue when compared to a "patient", who is taken seriously and treated properly according to the medical model?"
Yes, basically.
Yes, basically.
Bizarre. My take is the reverse of yours. "Patients" are classically dehumanized objects - and within the context of mental health service provision, had been traditionally deprived of basic human rights as part of their status.
"Clients," on the other hand, are participants in a transaction, which implies a consensual relationship between a provider and a purchaser of a service. My political biases are strongly classical liberal, so I tend to see the morality of markets as superior to the morality of the traditional, paternalistic doctor-patient relationship. But perhaps that's just me.
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This is the way I've mostly viewed the relationship between terms also. With the advent of "consumer", the idea (to my knowledge) has been that people receiving mental health care are not "just clients" but are also able to actively tailor their services in a way that makes sense to them, to be knowledgeable of what they receive. The equality of the relationship is elated to another level in a sense, because in some studies, "consumers" are involved in creating assessment tools and therapy techniques alongside clinical psychologists. The increase of knowledge may decrease stigma or perceived lack of availability, etc. etc., and so more people may be willing to receive the purchase our services.
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How come nobody has commented that sometimes, especially in IMEs, worker comp, and other forensic evals, the person being evaluated is NOT my patient, and is indeed a "client" of sorts. Well actually, whoever is paying me is the real "client," but you get the idea. And frankly, being wary of the baseline rates/probability of symptom magnification and malingering in certain populations is simply good practice.
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If I remember correctly, the popularization of the term is actually from movements within the circle of people who suffer from long term mental illness and are recovering/ recovered. They often prefer the term consumer, and at times, service users (versus service providers) because it gives them a sense of control.
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Absolutely-
The control issue was what I was trying to get at (maybe ineffectively) with the assessment tool example. The "consumer" label versus "patient" label allows people to interact with mental health providers on the same plane- they're making decisions about their care, they're understanding implications about their care (to some degree, given differentials in education level etc.). Particularly with people who are constantly working with psychologists, doctors, med management, etc. having a sense of control rather than being something for another person to keep under control via med management and evals is essential (IMO) for self-efficacy, etc.
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Sorry -- I just don't buy that there are legions of medical providers who are damaged goods, who can no longer provide decent, unbiased medical care, on account of this paradigm shift. I'd love to be convinced that the paradigm has upended the industry, but I've been around long enough to know it ain't so. Talk to anyone in the C/S/X movement -- old timer or newbie -- about their experiences as psychiatric patients and you're likely to hear stories of civil rights abuses masked as medical care, stigmatization masked as tough love, etc... Almost by definition, "patients" suffering breakthrough symptoms are suspected to be incapable of making decisions in their own best interests. Divorce the symptom driven behaviors from the person-hood of the patient, and "patients" become all the more susceptible to labels such as "crazy," dependent on others for care, etc. The dirty little open secret is that this divorce is almost never completely accomplished, so "patients" suffer mental illness and need care to the extent that they act in ways that piss people off (or more insidiously, simply confuse others). Then it's open season on patient abuse, character assassination, dismissal, abandonment, etc. Try treating your "clients" or "consumer base" that way and see how long you stay in business... Not saying there aren't clear cases where people experiencing serious cognitive impairment need firm interventions on account of being dangers to themselves or others. Even then being mindful of opportunities to operationalize the consumer paradigm has merit. Especially since after such triage style interventions the nitty gritty of day to day decisions about patient care are not always (able to be) justified by appeal to those life or death concerns...
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Just to play both sides, is it possible to be a 'client' or 'consumer' in a hospital or other inpatient situation?
In now way am I referring to patients in inpatient psychiatric settings, psychiatrists, or any other mental health arena. That is only a very small percentage of the overall population of people who seek help for mental health related issues; the majority go to primary care for depression, anxiety, insomnia etc. Again, it is in the primary care arena that I have seen this shift.
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Consumers is the term we are supposed to use at the inpatient hospital I work with.
I would be surprised if any primary care physician ever referred to their patients as "clients."
I don't think the title matters too much. And in fact, I read some time ago that therapists with the title "Doctor" actually have better results because clients believe help from a "doctor" vs. "Joe or Mary" is akin to healing. In other words, they buy into the expertise of the therapist and are more likely to take them seriously.
Now, I am not saying this is what I agree with. But it is an argument I have heard in the past. I can say, personally, that I have had therapists that were both "doctors" and "Joe, Mary etc.". I tended to regard the "doctor" more highly because I assumed they had advanced knowledge vs. someone going by a first name. However, this had more to do with their perceived level of education vs. title. In our culture, we think vary highly of doctors, so I can see how having the title might gain more immediate respect; however, how effective you are will ultimately determine the amount of respect you keep.
I won't lie and say I don't like the idea of being called doctor, but I certainly would never require someone to use the title. They can call me whatever is most comfortable for them. In my experience, this is the best policy. If clients are more comfortable calling you doctor, insisting they call you by your first name may make them uncomfortable. Conversely, asking them to call you doctor when they are more comfortable with first names may also place a barrier between client/therapist - so go with whatever feels most appropriate for the client. In the end, it is about them and not you anyways!
Now, I am not saying this is what I agree with. But it is an argument I have heard in the past. I can say, personally, that I have had therapists that were both "doctors" and "Joe, Mary etc.". I tended to regard the "doctor" more highly because I assumed they had advanced knowledge vs. someone going by a first name. However, this had more to do with their perceived level of education vs. title. In our culture, we think vary highly of doctors, so I can see how having the title might gain more immediate respect; however, how effective you are will ultimately determine the amount of respect you keep.
I won't lie and say I don't like the idea of being called doctor, but I certainly would never require someone to use the title. They can call me whatever is most comfortable for them. In my experience, this is the best policy. If clients are more comfortable calling you doctor, insisting they call you by your first name may make them uncomfortable. Conversely, asking them to call you doctor when they are more comfortable with first names may also place a barrier between client/therapist - so go with whatever feels most appropriate for the client. In the end, it is about them and not you anyways!
In regards to patient vs. clients, there are many good arguments for both sides. I see the point that calling someone a patient or client can dehumanize them. Coming from a social work background, I understand the implications for treating consumers as subordinate. We have to remember that there is much bias in our language. However, in the end, it is how we treat a person, not the labels we use that set the standard. You can call a person patient, client, consumer, joe blow, etc. but ultimately, treating them like they are equal and important is the most important aspect.
At one time, client was considered an appropriate, equal term. However, how we treated our clients changed what the title meant. We can choose a new term, like consumer, equal, etc. but how we approach them will define what that term means.
This. The whole PC movement drives me up a wall. Changing the name for something accomplishes very little beyond wasting many people's time and artificially creating pointless controversy surrounding a peripheral issue rather than the actual problem.
We should be fixing the actual problem. Calling patients clients to "humanize" does nothing unless clients are treated are actually treated more humanely...otherwise it just briefly delays people finding the term client to be dehumanizing. Same thing when it comes to insisting on "Dr." to gain respect in medical settings. I'm not convinced it is actually going to accomplish anything. Are there any studies showing it does (seriously, I'm curious)?
In my experiences, the vast majority of clients could care less what term they are called by. They care how they are treated as people, and whether or not they get better. Most of the folks I've seen are generally not thinking in these abstract, esoteric ways about the "deeper meaning" of the term. I'd be curious to see how often these movements have actually been spurred by the individuals themselves (i.e. patients, etc.) versus someone else deciding for them that it is offensive.
Ollie furthers my point. The mental image that a title, word, phrase, etc. evokes has nothing to do with it's definition and everything to do with the experiences associated with that term. I explicitly remember an experience I had in a community mental health center where I was told, by my supervisor, that we were to never refer to our consumers as "patients"; clients or consumers were the only appropriate terms. I asked her why and she said that, "We respect our clients and want them to feel as though they are an equal partner in their treatment here." On the surface, I could understand her point, but as I spent more time in this environment I realized that the "clients" were not treated as equals. They were degraded, belittled, and treated like children. So what difference does it make what term we use to refer to them as? If we are going to treat clients badly, than the image we are setting will be associated with that term. Recently, "Consumer" has been used increasingly to refer to clients as equals in the treatment process; but if our actions are outdated and we continue to act the same as we always have, than "consumer" will earn the stigma that " patient" and "client" did. Our actions create the stigma associated with titles.
... sometimes a word is just a word, and it matters more what we do with (or to) our clients/patients/consumers than what we call them. Sure, language can shape reality, but that doesn't mean obsessing about language is inherently useful.
That goes right back to my point. Being as physicians associate the word client with anything but a person seeking health-related services, the attempt by mental health PC to use language to change perception has completely backfired in the medical community.
I dont think that using the word client is stigmatizing word that demotes a person seeking mental health services to just a package of symptoms or stereotypes. Ive never worked with any mental health professional who believed that a "client" described someone who was crazy or problematic.
The fact is that the world client or patient is going to mean different things to different people based on the context of their own thinking and practice. I dont think there is anything inherently wrong with these terms but what matters more is the professional's approach to treating the person.
The fact is that the world client or patient is going to mean different things to different people based on the context of their own thinking and practice. I dont think there is anything inherently wrong with these terms but what matters more is the professional's approach to treating the person.
Please read my original post. I referring only to non-psychiatric medical providers (MD, PA-C, FNP etc..). I have seen a very large effect when a medical provider gets contacted by a mental health provider in regards to their "client", and how the assumptions (athough false) made by the medical provider skew their overall view of the person. This is especially problematic when the medical provider has not met the "client" yet as their patient and begins their interactions with the patient in a falsely prejudiced manner.
There is nothing inherently wrong with the term "client" that causes the medical provider to "skew" their impressions of the individual. What matters is the provider's approach and that is independent of the term "client." I think what needs to be changed is not the term but the attitude. We can change the word client to XYZ, but if the same mindset is still there we will never cease looking for new names.
There is an inherent problem with the term. The term "client" is not culturally meaningful in medical settings as the term "patient" is, so it gets an odd set of assumptions attached to it. Culture is a huge variable, and the exact same principle is seen with racial, gender, age prejudices and biases. I do think the overall reduction in the use of the N-word has helped to improve race relations because that word carried many negative connotations in addition to being an insult. "Client" is not an insult, but it is not culturally relevant in most of healthcare. By your logic, culturally speaking, we could all use the N-word again and as long as we did so but treated those of color as equals there would be no problem?
Indeed, that is a giant leap from the word client and a derogatory term used to describe a particular group of people. I also dont see any logic in the leap that you made regarding this example. There is an unequivocal agreement that the ethnic slur is not only culturally inappropriate, but that it is a grave insult. There are many of us here who disagree with your assessment of the term client and do not believe it has the connotations you believe it does. Your analogy does not hold water.
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I get it, sort of. However, I get it in a way that leaves me wondering if you mean to suggest systems theory is beyond the ken of non-psychiatric medical providers. Do they really experience humanity as divided into two groups -- "patient" and "not patient" -- and leave it at that? So that if a parent calls the doctor about a child, the parent must never refer to this person as a child, son/daughter, brother/sister, student, etc., but only ever the doctor's patient? Similarly, mental health workers accompanying their clients to medical appointments must leave their consumer-centric advocacy goggles at the door of the medical clinic lest they jeapordize the "patient's" care. I see from subsequent posts you sense that non-psychiatric medical providers may have a pejorative sense of the word "client." Thank you for the heads up that in discussions with non-psychiatric medical providers I've stigmatized my clients (and likely made an arse of myself) when I've used the "c" word... Guess I and my clients should either just get used to it or adopt medicalese since the balance of power favors these professionals and it doesn't pay to tamper with the status quo?
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The statement I placed in bold text seems to lack an object. To my understanding, the point is not "calling patients clients to humanize them" (since they do not lack for humanity) but "...to humanize the treatment environment" or perhaps even more honestly to simply call the machine a machine (since the label for people receiving care there is simultaneously a product of that environment/instrument of that shop). In that sense, it matters little who devises the new term (whether "PC" or not) -- the term will speak to those who (on whatever level) understand the historical context which justifies its adaptation, those who will (likely) "feel it" when encountering a true champion of the values the term is meant to promote as opposed to a huckster of the vocab. I'm not sure any studies matter, in this regard.
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