December 8, 2008, 12:12 am

Keep Your “Clients”, I Have “Patients”

Ah, the “positive suitcase sign”

Patients who wanted/expected to be admitted used to bring their packed suitcases with them when they visited the ER.

I haven’t seen it for years. People aren’t admitted like they used to be and the public has gotten the message.

This guy is really efficient. Pajamas? Check. Slippers? Check. Suitcase? Check.

Looks like he’s playing “rock-paper-scissors” with the triage nurse.

What a great triage system! If he wins, he goes straight to a room. If he loses, he goes to the waiting room.

********************

I’m restless. NASCAR is over until February. My Fighting Irish fought their way to…well let’s just say they fought their way. Brady Quinn gets finger surgery so it’s no fun watching my NFL team. I wonder if he needs a nurse.

(Oh… NEVER say that you wish a quarterback would sprain a finger so your back-up guy can play. That’s what I said about Derek Anderson last year and quarterback-karma came back and bit me in the butt.)

All I have to occupy my time is the ten-page paper on Hispanic health that is DUE ON WEDNESDAY! And all I can summon up the energy for is watching old reruns of Andy Griffith. It’s like comfort food for stress.

I have two pages done. Trust me, it was an extreme effort of the will to get that much on paper.

I’ll think about it tomorrow.

Hey, it worked for Scarlett O’Hara!

********************

I’ve noticed something in my community nursing readings.

The term “client” is ubiquitous.

It drives me right up the wall.

You see, I don’t have “clients”.

I care for “patients”.

*****

While clients purchase goods and services and while medical care is often referred to as a commodity, it is the only service in which people expose themselves emotionally, physically and spiritually, or share the most intimate details of their lives.

When they obtain medical/nursing care, they are looking for something more.

They are looking to be cared about while they are being cared for.

And that is the difference: caring.

*****

When I am giving nursing care, providing patient education or making a home visit I am providing a service to my patients, but embedded in that service is caring.

You can be a competent lawyer and serve your clients without caring. You can be an competent accountant and serve your clients without caring. A nurse who doesn’t care becomes a technician.

Caring is the essence of nursing.

And that is why my patients will always be my “patients” and never my “clients”.

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26 Comments

  • bladdergirl
    bladdergirl

    December 8, 2008 at 12:30 am

    What a great post! Finally someone who remembers he true values of what nursing is, and what it represents.


  • annemiek
    annemiek

    December 8, 2008 at 5:16 am

    I really, really do not like the way the new students are always referring to patients as clients. Where did this come from? Somehow I think this custom will make a U-turn too, as so many things do.


  • Katie B.
    Katie B.

    December 8, 2008 at 6:24 am

    For me, in the public health world, we didn’t have “patients” because the people we worked with typically were not sick – but they were vulnerable for some reason. Sometimes they were just people we were teaching a class to or offering immunizations to, so they were recipients of our services. I never called clinic clients “patients” as they found it somewhat offensive. I think it helps to bring the health care providers to the same level as the people they are treating/teaching, instead of the provider being somewhat superior.


  • Maureen
    Maureen

    December 8, 2008 at 6:45 am

    Thank God, a nurse who still understands about care!! Can we clone you? Or better yet, can you be in charge of training for all future nurses? I rarely get cared for anymore, but when I do, I go out of my way to let that nurse know how much it meant to me to be treated like a person and not a number or a faceless entity in a bed!

    Thanks for another great post and good luck with that paper!


  • Trauma Junkie
    Trauma Junkie

    December 8, 2008 at 8:06 am

    I couldn’t agree more with you.

    A lot of the nurses who have graduated in the past year constantly chart the word “client” when they are referring to their “patient.” I can’t understand it at all!

    It just seems to me like a patient is someone you are taking care of in the hospital, whereas a client reminds me of someone who is buying a good or service from you, more like a business partner.


  • Sara
    Sara

    December 8, 2008 at 8:37 am

    Are you sure that’s a patient and not an intern wearing ‘hospital whites’? With an overcoat & ‘doctor bag’?

    Just a thought. I love the old pictures.

    Sara
    Who also cares for patients,not clients


  • Strong One
    Strong One

    December 8, 2008 at 8:43 am

    Clients = patients.
    Goes to show you how commercialized Healthcare has become. Healthcare is now a business.
    Sad.
    Great point made.


  • Lionlover
    Lionlover

    December 8, 2008 at 10:25 am

    I agree with you. We were taught to refer to them as “clients” when I was in school in the late ’70s. I never really cared for it, though I can see how essentially healthy people in a clinic or getting home care wouldn’t want to be thought of as a patient. On the other hand, I remember sometime in the ’80s when nurses weren’t going to be called nurses anymore, we were all going to be health care providers. One of my supervisors said “I went to school to be a NURSE, not some health care “provider.”
    I’m not sure that’s a nurse in that picture. Where’s her cap? I don’t think you could be a real nurse back then if you didn’t have your starched white cap on. Or as they used to say (or so I’ve heard) “Where’s your dignity?” LOL!


  • DBS
    DBS

    December 8, 2008 at 1:21 pm

    My place of employment refers to the doctors as “Providers” and the patients as “Members.” Obnoxious words. When I address a physician I do not call her Provider X, I call her Dr. X. When I address my patients I ask them what they would prefer to be called Nancy or Mrs. Drew, not member Drew. Silly, silly words. By changing the names of all the people involved in the healthcare process it does not improve our healthcare system or the care people recieve. Nice try beauracracy.


  • Medic/Nurse
    Medic/Nurse

    December 8, 2008 at 3:18 pm

    Patients no longer show up at your hospital with packed suitcases!?!?!?! That is a daily occurance at my hospital. Now, very few of these actually get admitted, and most are removed, kicking and screaming, by security. But, there are few every day who demand “but I brought my suitcase, why can’t I stay?” Um, because we are a hospital for SICK people, and you don’t fit in that catagory!

    That aside, I agree with you on the patient/client disagreement. This was something we had long discussions about in some of my nursing theory classes. I have an ADN, but at my school that meant several nursing theory classes. During those disscusions, it was interesting to hear the various perspectives presented. The older nursing instructors preferred “patient”, while some of the newer ones preferred “client”. Those who preferred “client” cited that to them it brought to mind the sense of self-responsibility we try so hard to instill in our patients. They thought using that term helped empower people to make decisions and choices for themselves.
    While I can see the point they made, I personally still prefer “patient”. I think it definately brings to mind a much more compassionate picture. Because, lets face it, when I am to sick to protest being brought to the ER; I want compassion and care by competent staff. This is where “patient” seems much more appropriate. If I were going to a expensive stand-alone surgery clinic to get my face lift and boob job readjusted; then I might want to be called a “client”. Because, in this second senario, I would probably be rich enough to shop around and find the doctor and surgery center I wanted. If I have a case of appendicitis, I would be dragged by my friends to the nearest ER; I would not have the time or resources to evaluate my options and be known as a “client”.
    So, cheers to that rarity these days, an ER nurse who still cares!! Thanks, Kim!


  • Flo
    Flo

    December 8, 2008 at 5:22 pm

    I totally agree with you. I’m just finishing my first semester of nursing school and I’m going crazy with the thought of clients vs patients. I personally think that using client is detrimental and even wrote a whole post about it.
    ~Flo


  • Carol
    Carol

    December 8, 2008 at 5:46 pm

    Well stated. That’s the way I always thought about it too.


  • Christian Sinclair
    Christian Sinclair

    December 8, 2008 at 7:16 pm

    Don’t social workers use the word ‘clients’ often? Maybe it has creeped in from their common usage of the term?


  • AlisonH
    AlisonH

    December 8, 2008 at 11:01 pm

    As a patient who’s done my fair share of in-hospital time, if anyone were to ask my opinion, “client” reduces me to a line in a bank balance and nothing more. It horrifies me. I’m so glad to read that you’re fighting that mentality and trying to bring things back to where, for the patients’ sakes and the staffs’ as well, it so much needs to be.

    I’m sitting here thinking of the nurse at Stanford who noticed the bp was 64/40 and going down, instantly put a hand on my shoulder and asked me, her face turned to me for a brief instant and then going back to being glued to the monitor, “Are you okay? Hang in there!” I wasn’t, but that touch and those words gave me something to rally around when I so much needed it. I’ll never forget what a difference it made.

    Don’t anybody dare degrade me or her with the word “client” under circumstances like that!


  • yourerdoc
    yourerdoc

    December 9, 2008 at 6:59 am

    Thanks for the reminder. Emergency medicine has a way of dehumanizing patients in the eyes of the docs and nurses. Of course “clients” is superior to “utilizers” and I’ve heard that term thrown around a bit too.


  • [...] I am on board too. But, please, remember that caring is the essence of nursing. And that is why my patients will always be my “patients” and never my [...]


  • PM, RN
    PM, RN

    December 9, 2008 at 1:34 pm

    I think I’ve seen “clients” used more when there is more private sector involvement and obsession over “customer service”.

    One of our local hospitals has even gone a step further from that, dropping “clients” for “consumers”, shorthand for “consumers of health care services”.

    Back when I worked in a group home, they were “clients”, which made sense since they weren’t in a hospital or nursing facility and we weren’t (at that point) nurses. Most of the hospitals I did clinicals at insisted we use the term “clients” also.

    At the state mental hospital, we called them “patients”. At the skilled nursing facility we were told to call them “residents”


  • ERMurse
    ERMurse

    December 9, 2008 at 7:29 pm

    Great Post. The only term I find more offensive than “Client” when refering to patients is “Customer”. I was recently at a hospital in Las Vegas and the lobby looked like a fancy suburban mall or hotel lobby complete with Palm Trees, Sky Lights, and kiosks selling trinkets. Its a sad state of affairs when our medical dollar is targeting customers rather than patients. Reducing a patient to a customer or a client just sets the stage for reducing nurses glorified prostitutes.


  • Rick
    Rick

    December 10, 2008 at 10:27 am

    Hey, be careful there about patients bringing a suitcase ! I had a repeat collapsed lung and knew exactly what had happened so I took a shower, got my own PJs, ear plugs, eye shades, book and toothbrush in bag ready knowing from the previous stay that those items would be helpful. The ER front desk folks and triage nurse were very skeptical, but in about 25 min. I gave them a wave as I wheeled away for the old chest tube routine and admission. For the next couple of days I was glad I had all those items.


  • RehabRN
    RehabRN

    December 11, 2008 at 6:39 am

    I always had a bad habit of trying to switch between patients and clients when I was in public health clinical. Those PH profs always had a fit if we called their people “patients”.

    So, in order to keep my middle-aged addled mind out of trouble, I’d just call them by their names most of the time, or refer to them as Mr. X or Ms. Y when I needed to mention them anonymously. Or I’d just go to the old reliable, “Bob” and “Mary” fake patient names.

    That way I got around all the patient/client crap! Besides, the only thing that matters to the patient is that you are respectful and call them what they want to be called–Mr. So and So, Mikey, Ms. B, etc.

    That is customer-service at it’s best…even for nurses!


  • Bo
    Bo

    December 11, 2008 at 11:22 am

    When my hospital switched to the word “client”, I always screwed it up by stuttering whenever I had to use the word. I’d get so confused that I’d say “pa….cl…pa…uh…person?” whenever it came up in a sentence.


  • Beth
    Beth

    December 16, 2008 at 10:36 am

    I’m another one that’s shown up exactly once with a suitcase (at least through the ER). I knew I was ultimately going to be readmitted to the psych facility I’d just left a few days before, and came prepared with my own huge blanket (king sized, fuzzy, and ALL MINE!) and a suitcase. It had nothing to do with the current hospital, though I do know that the ER is always freezing and the blanket DID come in handy there.

    About terminology: the hospital that I’m most familiar with has everyone on staff referred to by first name. It seems pretty split with the doctors, but the nurses, transports, techs, everyone else is solely first name. And yes, half the doctors DO introduce themselves by first name. I have no idea how we’re referred to when they’re out of the room, but they come in making the assumption, usually, of first-name-basis. It doesn’t bother me, and I’ve asked the few who call me Ms. X. to please call me Beth. For the record, I prefer “patient”, insofar as I care, from my side of the blanket/needle.

    Do nurses ever resent not having a “title”? Do any of your doctors go by first name to anyone, nurses or patients? Do you prefer to go by first name–assuming you do–to preserve your anonymity while still providing a good bedside manner?

    Also, I apologize for being the one to make the stupid pun, but if you’re in the ER, you’re certainly not a “client”. Especially if you’re sick but not immediately emergent, how can you be anything but a “patient”? Nudge, nudge, wink, wink.


  • Peggy
    Peggy

    March 11, 2009 at 5:32 pm

    While I was working on my BS in nursing, the professors referred to patients as “clients”. I hated it then and now as a professor myself..I still hate it. I even had a Dr. ask me, “why do some of the students refer to their patients as clients? He stated, a client is someone who negotiates for your service. My patients don’t negotiate for my services in hospice. WE are there to care for our patients and their families. Same thing in the hospital, patients don’t much have a choice and don’t negotiate for nurses’s services. It seems to take the holistic caring part of what we do and drop it into a big and impersonal box. I will continue to refer to those who are in my care as my patients and I would be willing to be, not one of them would argue.


  • mary
    mary

    March 20, 2009 at 7:27 am

    Here in the our health system we treat ‘service users’. Moved on from client and consumer a year or so ago. Not allowed to care for patients anymore. I’m looking for a nursing position that might still treat patients. Got a job at your place Kim?


  • setupautofill
    setupautofill

    March 21, 2012 at 9:34 pm

    Hi there! You’re bleeding to death in our ER! We can fix that for $25,000 for starters! And since you’re our first client today, we’re giving you a ten percent price break.
    No then…if you’re a patient, we won’t talk best prices, or best practices, we’re just going to dive in, assume that you’re too sick to make those decisions and we’ll do what’s best for you.
    What’ll it be? Patient or client?
    Sign here…


  • Joey
    Joey

    August 17, 2012 at 4:46 pm

    “it is the only service in which people expose themselves emotionally, physically and spiritually, or share the most intimate details of their lives.”

    Thank you for stating in such clear terms that economics simply cannot be applied to medicine the way it is applied to every other industry. “Care” is a classic example of an externality that is ignored by the marketplace. Also, most nurses & doctors are on salary. Since “caring” means you take extra time to care, it counts as an additional labor cost. In short, “carers” lost monetarily, according to our system.

    Of course, I’ve long heard the argument that health practitioners should never go into medicine for monetary award. Although I agree with that, I also want our best (which IMO correlates with our most “caring”) practitioners to get rewarded. I don’t want our doctors & nurses thinking that to care means to lose monetarily and only benefit spiritually. As a consumer, I would gladly pay more for a practitioner that ranks higher in caring & compassion. We just have to figure out a way to do this through a third party so that practitioners don’t appear to be “selling” care as a commodity!


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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