Like the pine trees lining the winding road
I got a name, I got a name
Like the singing bird and the croaking toad
I got a name, I got a name
And I carry it with me like my daddy did…
What should we call people? As a physician I don’t have a problem with the term ‘patient’ but recognize its limitations. It doesn’t really empower individuals. With my PACT team we used the term ‘participant’ which I came to like. There are other options including ‘client’, ‘consumer’, ‘service user’ or one I’d not come across before – ‘Expert by Experience’.
In addressing the issue for social workers C. McDonald writes:
The words we use to describe those who use our services are, at one level, metaphors that indicate how we conceive them. At another level such labels operate discursively, constructing both the relationship and attendant identities of people participating in the relationships, inducing very practical and material outcomes (McDonald, 2006, p. 115).
I think there are merits to each of the various options – for a thoughtful consideration have a look at this article in the (click to view) British Journal of Social Work: What’s in a Name: ‘Client’, ‘Patient’, ‘Customer’, ‘Consumer’, ‘Expert by Experience’, ‘Service User’—What’s Next? British Journal of Social Work: What’s in a Name: ‘Client’, ‘Patient’, ‘Customer’, ‘Consumer’, ‘Expert by Experience’, ‘Service User’—What’s Next?
I do have a preference in terms of recording – I think clinicians should write using the patient/participant/consumer’s name. For reasons I haven’t yet figured out many clinicians feel they must write using ‘client’ rather than the individual’s name. I end up reading many, many notes that have the word ‘client’ many, many times.
If you’ve been reading my blog for a bit you know I love Motivational Interviewing. MI grew out of the work of Dr. Carl Rogers, who introduced the idea of using the word client. I support the non-judgemental acceptance Rogers advocated. However I don’t think calling people ‘client’ rather than using their name does anything in helping operationalize Roger’s ideas.
Years ago I asked the director of medical records at the large teaching hospital where I worked whether there was some medical-legal requirement to use the term ‘client’ or some prohibition on using names. She knew of none. I think some believe that using ‘client’ in notes somehow is indicative of good professional boundaries. I’m all for good professional boundaries but don’t believe using someones name in my notes in any way diminishes my commitment to maintaining such boundaries.
I like narratives. People’s lives are stories they share with us. When we document, why not make note of it as a story?
When you’re doing your notes this week try using the person’s name rather than the ‘c’ word. If you’re an ACT team leader consider using an educational session to raise this with your team and allow people to express their thoughts.
And thank you, Dear Reader, for your time.
Shalom Coodin, MD FRCPC