Embracing the P word.

“When it is not necessary to change, it is necessary not to change” – Viscount Falkland.

The Nursing and Midwifery Board of Australia is currently updating the codes of conduct for nurses and midwives in Australia. You can take a look at the drafts and consultative processes here..

Its worth taking a look at the drafts and comparing them to the much shorter existing version. You might even have something to add to the evolution of this code (which you can do here).

One thing of interest that jumps straight out at me is the codes struggle to identify exactly who it is we are delivering care to. The word patient is never mentioned.

Instead, the code identifies the people we care for as persons and our care delivery as person-centred practice. This it defines as:

Person-centred practice is collaborative and respectful partnership built on mutual trust and understanding through good communication. Each person is treated as an individual with the aim of respecting people’s ownership of their health information, rights and preferences while protecting their dignity and empowering choice. Person-centred practice recognises the role of family and community with respect to cultural and religious diversity.

The problem many people have with the word patient, is that is invokes a passive or subservient flavour to our relationsip. Patient comes from the Latin patiens, from patior, to suffer or bear.

This is seen as identifying an unequal or uncentered focus in what must instead be approached as a collaborative therapeutic relationship.

It also has connotations that the person is sick. A situation which may or may not be true in their relationship to the nurse at that particular time.

So in order to more empower the people we care for other words have been ushered forward as politically correct alternatives. These  include:

  • Client.
  • Consumer.

Both of which impute a similar one way movement of energy, or of the person somehow being in a mostly passive position of reception.

Then there is:

  • Partner.

Which somehow often completely fails to capture the authenticity of the relationship as, for example in the demented, intoxicated, developmentally delayed, critically unwell, acutely psychotic etc. In these cases there is no partnership with the person themselves (although there may well be with family, friends etc).

So in the draft code of conduct for nurses, we have person.

We care for people and deliver people centred care. Well yes, that sounds fine. But it is bland and blurred. It misses the special boundaries, responsibilities (to both parties), shared experience and dynamics that truly exist between a nurse and the person with whom they are providing care to, compared to persons not directly in that intimate relationship.
Even though family members and community play a vital role in process and at times the shared decision making, it is a different set of boundaries.

When working as a nurse I deliver person centred care. But to a very specific and special person. My patient.

They are my patient. I am their nurse. I am not their person. They are not mine.

Patient.

So personally I think we should re-embrace the word patient.
And we should give that word the meaning that it requires and deserves.

Already, most everyone knows that when you say patient you are immediately referring to a medical context. It clearly and succinctly identifies a person within place and in relationship to a care-giver.

Language is in constant evolution and flux. As with so many other words in the English language, meanings can change over time.
When you have such a specialised word that already contains rich meanings and identity it seems such a waste to throw it aside to be replaced by far more inferior descriptions.
The word patient can grow to have the precise meaning we need. We only need to feed it.

Patient is a term that is loaded with historical, sociological and political significance in terms of its relationship with disease, society and health professionals. Rejecting it is in part an attempt to tackle the associated disempowerment and balance unequal relationships.

Whilst well-intentioned this rejection has been co-opted by modern neo-liberal capitalist ideology. This dis-empowers individuals by devolving responsibility at the same time as widening economic inequality and undermining social solidarity. True patient empowerment comes from the process of co-production within a respectful therapeutic relationship. The term ‘patient’ is both flexible and resilient enough to stand above all the alternatives. It allows patients to be clients and consumers, to teach and be taught, to refuse care and be cared for. It recognises that doctors and patients are stronger when they work together and it confers on doctors [& nurses] a duty of care that is a vital part of the doctor-patient relationship. (A Better NHS 2017).

I think it is time we embrace the P word.


References

  1. A Better NHS. (2017). What’s in a name? Patients, clients and consumers. [online] Available at: https://abetternhs.net/2012/04/09/whats-in-a-name/ [Accessed 15 Feb. 2017].
  2. KevinMD.com. (2017). We need a new word for patient. [online] Available at: http://www.kevinmd.com/blog/2013/11/word-patient.html [Accessed 15 Feb. 2017].
  3. Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia – Current Consultations. [online] Available at: http://www.nursingmidwiferyboard.gov.au/News/Current-Consultations.aspx [Accessed 15 Feb. 2017].
  4. PubMed Central (PMC). (2017). Do we need a new word for patients?. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116090/ [Accessed 15 Feb. 2017].
  5. Scott, E. (2017). The Term “Patient” May Describe Me … But It Does Not Define Me | Journal of Participatory Medicine. [online] Jopm.org. Available at: http://www.jopm.org/opinion/commentary/2010/12/29/the-term-patient-may-describe-me-…-but-it-does-not-define-me/ [Accessed 15 Feb. 2017].

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