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TODAY'S TOPIC:
Patient, Client, Consumer
by
Natalia J. Garland
Print Version
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Lately I have noticed a new trend in how salespeople greet me in
the stores. That is, if they greet me at all. They say, as they
continue walking by me, "How are you today?" Before I
have time to respond, "Fine, thank you," they have
already passed by me. Then, before I can finish the niceties
with, "And how are you," they are out of hearing range.
When I check out with my purchases, the cashier says, without
making eye contact, "Did you find everything you need
today?"
There was a time
when salespeople would ask, "May I help you?" In
clothing stores there were employees who would assist customers
with finding sizes, colors and styles. They would carry your
items to the dressing room for you, and then stand by to offer
further help. They were knowledgeable about fit, and would give
you an honest opinion on whether that new dress really draped
right.
Why has the
language changed? It seems to me that salespeople are being
trained differently because employers have hired them mainly to
stock shelves rather than to assist customers. In many stores it
is very difficult to find a salesperson. Whether in a department
store or a bookstore, I have to go and look for someone if I need
assistance. Salespeople no longer walk the floors, tending to the
customers in their section (somewhat like waitresses still do in
restaurants). Whenever I locate a salesperson, it means
interrupting stock work or taking a cashier away from the
register.
Here is another
language change that I have noticed: pre-owned vehicles. I no
longer see any used car lots. Is this linguistically deceptive?
Or is this just an attempt to give used cars a little more
dignity? Taken literally, it does not make sense. What is a
pre-owned vehicle? Is it a car that was previously owned but
never driven? That is absurd. A pre-owned vehicle is, of course,
a used car. Everybody knows that. If a car has 120,000 miles on
it, it doesn't matter what you call it--it's been driven. The
reality has not changed.
The above are two
different examples of current changes in our everyday jargon.
The example of salesperson language reflects a change in the
reality of the work which, in turn, affects the quality of the
customer relationship. The example of pre-owned cars reflects a
cosmetic cover which anybody can see through.
What about some of
the language changes that have taken place in social work? If an
individual is seeking professional help, are they a patient, a
client, or a consumer? In terms of clinical social work, the
words patient and client can probably be used
interchangeably. Patient seems to mean that the person is
sick and in need of care. Some people object to this medical
model. Some professionals who emphasize a strengths-based or
empowerment approach to the practice of social work prefer the
terms client or consumer. A client, however, could
be someone who seeks any kind of professional services from
psychotherapy to interior decorating. A consumer could be someone
who goes shopping and purchases a product.
We need to keep in
mind, however, that there is nothing wrong with being sick.
People are not morally defective if they need care. Allowing
oneself to be a patient and to receive care could be liberating
for some people. Perhaps social workers need to be cautious
about not reinforcing the stigma of getting help for emotional
problems. Dropping the word patient from our vocabulary
might in itself reinforce a sense wrongness about having
emotional disturbances or other challenging issues.
Although I did
some research, I could not find exactly who was the first to borrow
the term consumer for use in social work. Most of us would
probably agree that we live in a consumer society. Perhaps the
realities of managed care (note that even the insurance providers
continue to use the word care) and the increased instances
of malpractice suits has prompted even some clients to think of
themselves as consumers of a service. The word consumer is
more empowering and could be felt as more equalizing. It means
that individuals can make informed choices regarding therapies and
therapists, and take legal action if harmed.
Let's discuss one
more language change before closing today's essay. For those of
you who conduct group therapy sessions, do you have some
individuals (or colleagues) who refer to group therapy as a class?
Even if you conduct psycho-educational groups, there is still a
difference between a group situation and a traditional classroom.
If individuals who seek help refer to group as a class, then this
means that they are students and that you are a teacher. The issue
of patient/client/consumer has been completely eliminated. And,
you have lost your job as a social worker and you are now, presto,
a schoolteacher.
The reason that I
have language on my mind today is that I wonder how all this
affects our concept of relationship. If an individual is a
consumer, are we engaged in a business transaction rather than a
therapeutic relationship? Has the reality of the profession
changed, such as seems to be true with salespeople? Or does it
remained unchanged, as is true with pre-owned vehicles? If an
individual refers to group as a class, is that individual in
denial? If a social worker passively accepts the role of teacher,
is there a shift in professional identity?
How precise do we
need to be regarding our use and the public's use of professional
terminology? The individuals who come to us for help are possibly
all three: patient, client, and consumer. They are patients or
clients in their need for care from a qualified professional and
in their willingness to participate in their own growth. They
must also be smart consumers who have the wherewithall to walk
away from a therapist with whom they are dissatisfied and to take
legal action if appropriate.
Those who refer to
group as a class should probably be evaluated on an individual
basis. Their language could indicate the presence of defense
mechanisms which need to be addressed in therapy. Or, it could
simply indicate ignorance or confusion. (If you work in a facility
where various levels of services are offered such as community
education classes, psycho-educational groups, and psychotherapy
groups, then it is necessary to clearly distinguish one from the
other.)
It reminds me of a
time when I was doing a home improvement project. I went to the
hardware store and asked for a bag of cement mix. The salesman
corrected me and told me that it is called concrete mix. Cement,
he explained, is an ingredient in concrete. On the one hand, I
appreciated the information and I have never made that mistake
again. On the other hand, I thought he seemed a little arrogant.
He knew what I meant, and he could have sold me the concrete mix
without correcting me. Either way, it would have had no impact on
my ability to complete my home improvement project.
Although accurate
language is essential to communication, I suppose it is possible
to get too picky. As professional caretakers we need to be
secure in our identity and make sure we understand the scope of
our work. If someone makes an innocent error in their use of
professional language, we cannot take it personally. If there
are deeper emotional issues involved, or if there are political
ramifications, then we must respond in a way that promotes the
wellbeing of those in our care and the purpose of the profession.
(Written 03/07/05 - Revised 08/01/06: bibliography available.)
Addendum
I'm still not
certain who was the first to refer to patients/clients as
consumers in the practice of social work, but the
theoretical concept of consumerism possibly developed after
the passage of the Rehabilitation Act of 1973 and was related to
the treatment of people with disabilities. For more information,
see "Evolution of Consumerism in Rehabilitation Counseling: A
Theoretical Perspective," by Donna R. Rhoades, published in
the Journal of Rehabilitation, April-June 1995.
The following might
be among the earliest instances of the use of consumerism in
social work. Robert Perlman wrote Consumers and Social
Services in 1975. Burton Gummer wrote "Consumerism and
Clients' Rights" which was published in Handbook of
Clinical Social Work in 1983. There are undoubtedly other
instances: it is just a matter of having access to old social work
textbooks and scouring the bibliographies to find them.
The following two
paragraphs are quoted from "Down and Out in America," an
article by Liza Featherstone which was published in The
Nation, in the December 18, 2004 issue.
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The invention of the
"consumer" identity has been an important part of a long
process of eroding workers' power, and it's one reason working
people now have so little power against business. According to
the social historian Stuart Ewen, in the early years of mass
production, the late nineteenth and early twentieth centuries,
modernizing capitalism sought to turn people who thought of
themselves primarily as "workers" into
"consumers." Business elites wanted people to dream not
of satisfactory work and egalitarian societies--as many did at that
time--but of the beautiful things they could buy with their
paychecks.
Business was quite
successful in this project, which influenced much early advertising
and continued throughout the twentieth century. In addition to
replacing the "worker," the "consumer" has also
effectively replaced the citizen. That's why, when most Americans
hear about the Wal-Mart's worker-rights abuses, their first
reaction is to feel guilty about shopping at the store. A tiny
minority will respond by shopping elsewhere--and only a handful
will take any further action. A worker might call her union and
organize a picket. A citizen might write to her congressman or
local newspaper, or galvanize her church and knitting circle to
visit local management. A consumer makes an isolated, politically
slight decision: to shop or not to shop. Most of the time,
Wal-Mart has her exactly where it wants her, because the
intelligent choice for anyone thinking like as a consumer is not to
make a political statement but to seek the best bargain and the
greatest convenience.
[End of quote.]
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If the
business-tactic outcomes of consumerism are given credibility, then
social workers might be wise to reconsider their purposes for
having adopted this term. Is the profession empowering people, or
possibly eroding the concepts of and the power of people for
self-awareness or problem-solving? Are clients being
stripped of their capacity for introspection, insight, reasoning,
and relationship? Should a person have a right to be a therapy
patient and to choose, as a consumer, to seek help
from a professional expert? In the attempt to find a positive
alternative to the medical model, perhaps some practitioners have
turned to a business model which also may prove to be inadequate
and corruptible. (Written 08/29/08)
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