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What’s In A Name? Patients? Customers? Or Partners ?

In my first clinical year in level 500 while taking history from a patient, I asked , “Are you a sickler ? ” The patient, a lady , responded no. Knowing why she had reported to the hospital and subsequently been admitted, I was surprised so I asked “Are you sure or you haven’t tested before?”

She replied , I have Sickle cell diease but please am not a sickler”

The import of her response has since stuck with me and serves to remind me from time to time when  I stray while asking similar questions and or referring to patients in similar manner. 

For many health workers, calling those receiving care by their condition eg “that cirrhosis case” or the procedure eg the I&D case, the Team managing them eg. “the maxillofacial case” or simply “the case” is not uncommon. Indeed it has become subculture, so much so that we are able to remember these characterizations but oftentimes are unable to remember their names. 

Thus discussing how we consider these “cases” and its implications for the care we give may sound mundane and of no merit. However to those we are privileged to treat, it may matter a lot, at least on a subtle level or better still when we or our loved ones become cases so to speak.

On the surface, being called a patient is generally benign. However, the feelings and mental picture of suffering usually associated with the word are far from pleasant hence the need to use more pleasant and empowering words to describe same.  The Ghana Health Service has championed change and now patients are referred to as clients.

So who is a patient?

Derived from latin word patiens, the word Patient originally translates as “the one who endures or suffers”. Thus irrespective of whether the person is an outpatient or inpatient, the word typically refers to a sick individual who seeks the services of a healthcare provider to ease his or her suffering.

They are helpless by themselves, often in pain, confused and vulnerable having been rendered so by

A patient must therefore rely on others for their health and well-being; patients are not self-sufficient and lack total control over their situation. Handing control of one’s body to caregivers is a great hurdle patients cross to seek care and this has a significant impact on their health seeking behaviours. 

For a caregiver, this perception of a patient may subconsciously influence how patients are treated eg. A caregiver who views patients as helpless may not seek their participation in their care and rather issue out instructions to them irrespective of their social or financial status. They can be dehumanized and stripped off their rights without realization. This perception of a patient can potentially lead to tension with doctors, nurses and administrators, with implications for service delivery outcomes.

Who is a Customer or Client?

Simply put a customer is a person who seeks a service which in this case is a solution to a health issue. However typical customers in the service often are generally well people who at least are treated with some respect by virtue of their potential to purchase goods or services. Customers also have the power of choice according to expectations that the services they require must meet. Hence customer satisfaction, customer care, customer expectations, service quality have evolved over the years to become key components of service delivery.

From the medical point therefore, the medical customer is empowered to make choices and decisions; they can reasonably expect quality service and respect from us caregivers while in our care.

Patients are not customers in a traditional sense. The ‘goods’ they are purchasing are a return to health and the ‘services’ they seek often require a high level of trust in their ‘service provider, to whom they entrust their very life, unlike the typical customer buying phone credits or fried yam in Bantama.

Some authorities argue that viewing patients as consumers may be detrimental to the doctor-patient relationship. While it facilitates an emphasis on respect for patient autonomy, it inadvertently results in the commodification of health care ie. treating healthcare like a mere commodity and may contribute to increased medical litigation.

How about Partners?

In a partnership, the partners are assumed to have equal standing. The new thinking is to consider patients as partners in their care and in the health system so that the patients, instead of being passive and helpless, people, play an active role at every stage of their care.

Hence patients will need to be properly educated and informed right from their diagnosis, available options for treatment to the prognosis to enable them make informed decisions at each stage of their management. Improving population health requires the engagement of all stakeholders including patients, in making healthy decisions.

Patient as customer and partner

By treating patients as customers, facilities and caregivers can earn their respect, loyalty and hence, their business. The importance of this may even become more important in the light of the imminent implementation of the Capitation scheme where patients will have the power to choose their preferred primary care facilities hence essentially determining to some extent financial inflows in that regard. By treating patients as partners caregivers can provide more individualized care where patients are involved in decisions affecting their health. Irrespective of how we consider patients, it is more important to realize that the modern day patient though may be more sophisticated still have needs which the care giver must attend to efficiently.

They want to feel that they are the most important people on the caregiver’s mind. They want to be kept informed, talked to (not talked at) and to be active participants in their own treatment. As providers of hospital care we play a dual role; on one hand we are in the business of serving ‘customers’ and, on the other, a medical team caring for patients. We do also play a third role when we actually become patients and consumers of the care we give.

A blend of these various perceptions and how we harness their influence on the care we give is essential in the attainment of excellent clinical outcomes, patient satisfaction and consequently the financial success for our facilities be it public or private.

Dr. Richard Selormey