I appreciate and welcome the response to my piece regarding the use of patient vs. customer. I particularly enjoyed reading the response by Gael Hannan (and not only because she had nice things to say about my writing). I must admit that I wrote that piece in, let’s say, an enhanced state of mind. I wouldn’t say I was piqued, but my passions were aroused. I stand by everything I wrote, but perhaps a bit of nuance is in order.
This whole discussion inspired me to conduct a small, completely unscientific survey of friends, colleagues and acquaintances via email and Facebook regarding whether they would prefer to be referred to by health professionals as “patient” or “customer”. I wanted to see how off-base I might be in my preference. The results (with a ridiculously small n=38) were:
Patient – 56%
Customer – 32%
Client (write-in candidate) – 11%
Other – 1%
I would not stand before an AAA audience with these results – they are what they are.
If you look online there is a lot of discussion around this question and very little consensus. Many of the articles have a lot of “on the one hand, this and on the other hand that.” (Was it FDR that said he wanted advice only from one-handed economists?)
In the original piece, I could have said that my experience as a fledgling audiologist certainly had something to do with my opinion. My first boss in audiology once sat me down and gave me a good, finger-wagging talking-to about using the word “patient” rather than “client”, and I took it to heart. Due to his academic training and personality, he was inclined to have quite a patriarchal attitude toward his patients (“I am the doctor and I know best. You just do as I say and you will be fine.”) This is an attitude that I now reject, regardless of the designation: patient, customer, client, or person with hearing loss.
The “sage on the stage” view of hearing care is fundamentally flawed because it challenges the patient’s autonomy. It says “I know what is best for you, so just do it.” Who would not balk at such an approach, guaranteed to lead the patient to dig in his/her heels? A collaborative approach, in which the hearing care provider guides and motivates the patient to a positive decision, engaging Motivational Interviewing techniques is likely to be far more effective.
This is part of the reason the term “customer” is gaining currency. A customer is perceived to have more agency in the direction and outcome of their healthcare journey than a patient. “The customer is always right.” The patient must be allowed to indicate the direction of the process in terms of their needs, motivations, attitudes, with the guidance of a compassionate and competent hearing professional.
I do stand by what I wrote, but I also understand the patient who once said to me, “Why do you keep calling me a patient? I’m not sick.”
I wish I could be more like Quincy. Jack Klugman played Quincy in a TV drama from the 70s; a passionate and opinionated medical examiner. In every episode, at about the 2/3 point, Quincy would go off on a self-righteous rant. I loved it! And I wanted to be like him. It was only when I entered this profession that I found ideas worth advocating as passionately as Quincy did every week. But for me, the old 2-handed wishy-wash is always right around the corner, ready to take the steam out of any argument.
I will continue to refer to the people who come to me as patients. I certainly respect the designation “person with a hearing loss”, it just seems a bit clunky – lacking that certain je ne sais quoi. But I will also continue to treat my patients with respect and with full knowledge that they have functioning, independent brains and that what I do is not particle physics. If my explainer is good enough, and I have enough compassion, I can guide them to the best decision for themselves and their loved ones.
Paul U. Teie, MS, has been an audiologist since 1991. He has spent much of his career in direct clinical care but has filled other roles in the hearing care industry as sales representative of a special instrument dealer and a hearing instrument manufacturer. Since 2007 he has provided sales and clinical training for large hearing care networks and currently trains for HearUSA/HearCanada.
*featured image courtesy flckr