“But if thought corrupts language, language can also corrupt thought.” ―George Orwell, 1984

Some mental health clinicians call the people they treat, patients; some call them clients; and a few call them consumers. What is going on here?

The word patient comes from the latin verb pati meaning to suffer and implies the presence of an illness that requires medical intervention. The doctor/patient relationship has an ethical dimension: the duty to care for the patient goes beyond a commercial transaction.

Client as it is used in contemporary mental health care derives from the mid twentieth century humanistic, collaborative approach to psychotherapy of Carl Rogers. His theory of Client Centered Therapy was a reaction to the authoritarian approach to psychiatry of that time, an approach he believed blocked self growth and self realization because it did not empower clients to discover solutions for themselves. Many psychologists and other non-medical clinicians use clients in lieu of patients.

The term consumer is also used by some clinicians. The term came in in the 90s. It comes from the field of economics, specifically neoliberal economics. It was an attempt to give more dignity and power to the recipient of services by emphasizing their role as an economic agent.

Calling recipients of care clients to avoid association with the paternalistic medical model made sense 50 years ago when Carl Rogers was active. But it doesn’t anymore. The growing recognition that many medical conditions (diabetes, heart disease, etc) are biopsychosocial in origin (e.g. due to lifestyle issues such as smoking, drinking, obesity, diet, etc) has changed medical practice and made it less paternalistic and more collaborative.

For the majority of clinicians who see a broad range of people and take insurance, patients is probably the most respectful term today because it acknowledges the patient’s suffering as well as the ethical duty of the clinician to care. Arguably, the term client was more respectful when medicine was more paternalistic, but the term’s lack of recognition of suffering and ethical dimension makes it a less appealing choice now. Consumer is appropriate only in the very narrow mercantile sense of making a purchasing “decision.” Using the term more generally diminishes the recipient of care by denying their suffering and the clinician’s duty to care. Indeed, consumer seems a particularly abhorrent term as it implies the commodification of services as patients become customers, healthcare professionals become contracted workers, and healthcare becomes a business like any other. [polldaddy poll=8831307]