What´s in a Name?
By Kimberley Barreda
Are amputees patients of prosthetists, or are prosthetists service providers of amputees? And does it matter at all? Well, it depends on whom you ask.
An ongoing joke between my prosthetist and myself goes something like this:
He says, “What’s my favorite ‘patient’ going to do today?”
I say: “I think I’m going to fire my prosthetist and hire a new one.”
We both chuckle for a few seconds and then we get to work.
Sounds silly doesn’t it? It is… but it lays the foundation for something very serious – our working relationship. And while it may seem so, our relationship isn’t at all adversarial. Actually, it works to ensure that I get what I’m paying for, and he employs his training and experience to build and sell a great product with a high degree of quality and workmanship. It puts the responsibility exactly where it should be – on both of us.
And it works to ensure that the limbs I’m paying for fit properly and are suitable for my lifestyle. Together, we decide what I’m going to buy, what type of socket best suits me, and what I expect to get from them. Then we spend as much time as needed to make them “perfect.”
I leave a happy customer and he’s happy with his check… the client/provider relationship working as it’s supposed to.
Some people though (amputees and prosthetists alike) don’t see why they should be “clients” or why it can be patronizing for a prosthetist or manufacturer to refer to an amputee as a “patient.”
In my opinion, that’s unfortunate.
In my opinion, it’s one distinction that can make a real difference in an amputee’s quality of life. It takes us from being “cared for” to caring for ourselves.
Some amputees don’t care either way. You could call them a turnip and it’s ok with them. Others, mainly new amputees, are fine with being called patients, but many “seasoned” amputees who I know feel the proper label is client or customer. Personally, I feel that as a consumer of prosthetic devices, and the person choosing who builds my limb, makes me a client.
Is it just semantics? To most, probably yes. But I feel that the term “patient”, when used by receptionists, sales reps, prosthetists, or anyone else who is not a doctor, nurse, dentist or other medical professional is not only insulting and patronizing, but misrepresents our actual relationship, which I consider a business relationship.
Approaching the relationship as a business partnership puts the amputee in the driver’s seat with the prosthetist (which is a good metaphor when you consider how much an artificial limb costs these days… you could go out and buy a new car with the money for one. Just ask any prosthetist).
Taking the car metaphor a bit further, it becomes even more relevant. The car will be a major part of your life for years, and it’s “spendy”. Armed with a basic idea of what you want and need, you wander around the lot, you go to another lot, maybe a few more. You even read the classifieds to find that perfect deal. You take the time to research. During the buying process, you certainly wouldn’t let the salesperson tell you what kind of stereo you’ll be getting, or let him/her choose the color or model and make.
Unfortunately, many new amputees do just that when they purchase a prosthesis. The hospital recommends a prosthetist. They don’t shop around. The prosthetist shows them their options. They don’t shop around. They don’t communicate to the prosthetist any problems with the prosthesis (granted, for new amputees it’s difficult to decipher what’s a fitting or functional problem and what is now a fact of life). They leave and simply hobble around.
To get some perspective on the “semantics” issue from the prosthetist community, I signed on to the www.oandp.com mailing list and asked prosthetists why we are, for the most part, still called patients (see below for a sampling of responses).
It was heartening to read the responses from prosthetists who said they refer to amputees as customers, clients or simply by name. What a concept! But it was also very telling to hear the other side.
The reasons were varied, from “doctor’s orders” to “said so in their training” to “improves level of care” we receive when we’re considered patients.
A dictionary definition of the term patient accompanied the “care and concern” justification more than a few times
(Patient; noun; date: 14th century;
1 a : an individual awaiting or under medical care and treatment,
1 b : the recipient of any of various personal services;
2 : one that is acted upon).
But I’m not “awaiting or under medical care and/or treatment”. The issuing of a prescription is strictly procedural for the legal protection of the prosthetist and to assist in payment from insurers. The assembling of an artificial limb is not practicing medicine.
I’m the recipient of personal services from my hairdresser, dry cleaner, and taxi driver, but that doesn’t make me a patient.
And “acted upon”?… I’m involved in the process of my prosthetic purchase, and I am not acted upon. All actual work is done to the artificial limb.
I also don’t consider the casting of a limb and measuring for fit to be medical treatment; it’s part of building a custom item.
Some responders felt that the patient label, given to us by the medical profession, “follows them [us] right through the process and into our front door.”
Exactly, this is the problem. But this is where the buck should stop (well, it does actually in literal terms).
We don’t need to be called patients or be treated like patients. That’s not a prerequisite to receiving good service.
I want my prosthetist to care about me, not care for me (and, believe it or not, some have really not cared for me at all!).
I want him/her to build me a leg, and I want it done quickly, professionally and properly. Then I want to pay for it, leave with a good limb and get back to my real life.
While I did feel some of the responses were awfully condescending, I did appreciate that these prosthetists cared enough to take the time to help me better understand their point of view. And while I can understand the sentiment behind those responses – that these individuals care about the service they provide and about the people they provide the service to – I just can’t buy into their reasoning.
I don’t have to be thought of as a “patient” for them to provide caring service and a wonderful product. Because they care… I am a patient. No thanks.
How about: Because you care to do good work… I pay you.
Is buying an artificial leg a medical procedure? No. You don’t need a license to buy prosthetic components. I can buy used ones on Ebay. They’re not restricted, they’re not weapons.
Is building an artificial leg a medical procedure? Granted, it takes a whole lot of know-how to replicate a human limb, but a medical procedure? No.
The real bottom line here is one of respect. My prosthetist for me and I for he.
Now, back to definitions.
The word “patient” is an adjective too; actually, it’s listed in the dictionary before “patient” as a noun is. (Kind of like who came first, the amputee or the prosthetist?)
Ready for this?
Patient; adjective; date: 14th century;
- bearing pains or trials calmly or without complaint;
- manifesting forbearance under provocation or strain;
- not hasty or impetuous;
- steadfast despite opposition, difficulty, or adversity;
- able or willing to bear.
Now that’s more like it. Bearing the pains and trials of antiquated attitudes and policies.
How do you define yourself?
Dear Prosthetist:
My name is Kimberley Barreda and I write the “Hot Topics” column for Active Living magazine.
We’re covering the Patient/Client terminology debate and I’m looking for opinions from prosthetists regarding your use of “Client” or “Patient” and your reasons for either.
Thank You
Kimberley Barreda
Active Living magazine
As a healthcare administrator and President of an Orthotic and Prosthetic Practice, it is my opinion that since we are healthcare providers and normally our “services” are included as part of a treatment plan, the appropriate term for our “end users” or customers is truly “PATIENT”. In the alternative, a Durable Medical Equipment Supplier who is merely shipping or delivering a “piece of equipment” and not rendering a professional service (such as evaluation or fitting) might refer appropriately to their “customers”. I hope this is helpful.
Eileen Levis
President, Orthologix
Hello Kimberley,
Thank you for your interest in this question, as it does pop up on the P&O Listserve from time to time. My own protocol is to refer to persons with amputations as “patients” when they are in a hospital program actively receiving nursing care along with their prosthetic treatment. Once they are discharged from the hospital and I see them independently of other medical intervention I refer to them as my “clients”.
Geoffrey Hall, B.Sc., C.P. ( c )
Custom Prosthetic Services Ltd.
Good question.
I worked in the physical therapy field before becoming a Certified Prosthetist, so I have a long history of using the term “patient”. As a prosthetist, I’ve continued using “patient” in all texts except in legal documents. For example, on a consent form I use “client/patient” to cover all the bases.
I find it ridiculous that there is a squabble about the terms. The persons with the amputation behave as if we are medical professionals, they make appointments, are seen in exam rooms, have their insurance pay for services/devices, and do not seem to mind being referred to as the “patient.”
I’ve heard that the term may be fostering dependence or codependent behavior... somehow not allowing the individual to “escape” the healthcare arena. Well, isn’t that more due to how the medical professional interacts, educates and “treats” the individual?!
Rick Milen, CP
My dictionary (The American College Dictionary) states, as the first definition, that a “client” is “one who applies to a lawyer for advice or commits his cause or legal interests to a lawyer’s management.” Only as a second definition does it state that a client is “a customer”.
The same dictionary defines a “patient” under the first definition as “one who is under medical or surgical treatment.”
Since most prosthetic work begins with a medical prescription, it is a medical treatment. Warm fuzzies aside, I always refer to individuals as “patients” in my notes, and in discussions with other medical professionals.
Ed Neumann
Patient
Ron Scaglione, CP
Scaglione Prosthetics Inc.
Hello Kimberley,
Definitely patients, I do not sell to my clients, I treat my patients.
John Hattingh LPO
Hi Kimberley,
You’ve definitely picked a good topic to write about. I recently graduated from the O&P program at Northwestern and noticed that several people there referred to amputees as clients. I have always referred to the people I see professionally as patients. I have been an amputee for 28 years and have been a patient of several different prosthetists. Now that I am a Prosthetist/Orthotist, I am part of an Allied Medical Health Team. I work closely with doctors, therapists, and other health professionals. I am an important part of that individual’s treatment and care and that best matches the Miriam-Webster definition of patient.
Christopher Phillips
Prosthetist/Orthotist
New England Brace Co.
Hi Kim,
Jack Richmond here. I’ve written a couple of tongue in cheek articles dealing with this topic. I know where you stand on the issue and respect that view. As far as I’m concerned call me whatever you want, just say it with respect for me as a recipient of your services.
Jack Richmond
P.S. What’s in a name? Willie Shakespeare said, “A rose by any other name would smell as sweet.” Out where I live we say “You can call a skunk whatever you want, you still can’t bring it in the house”.
P.S.S. Following the example of the 10-page lease on my new pickup truck, I am known as the “Lessee” as I received the lease of the vehicle. The bank is known as the “lessor” because it gave me the lease. So, henceforth Prosthetic recipients will be known as “The Prosthetee” and the individual delivering the device will become the “Prosthetor”. It follows then that the Orthotist becomes the “Orthotor” and the recipient of said device becomes the “Orthotee.” In some areas of the south, “Bracer” and “Bracee” may be substituted.
Hello Kimberly,
I can speak from both sides of the table. I’m not an amputee but I am a polio statistic and wear a Left KAFO for stability and independent ambulation. When I transfer onto a table and entrust my quality of life to another, I would rather be their patient than their client. When a health care professional accepts me as a patient, I feel that I can share my personal challenges and frustrations in trying to stay independent so they can help me provide for my family and enjoy life to the utmost of my ability or disability. I want my health care professional, in this case a qualified orthotist, to provide me a service not sell me an orthotic item. I personally provide orthotic and prosthetic services to my patients along with the appropriate orthotic and or prosthetic device. I feel that I am personally involved with those requesting my services as a patient/professional. I have client relationships with my plumber, mechanic, and my Harley Dealership (My two cents).
Mark K. Taylor, MLS, CPO
Director of Clinical & Technical Services
University of Michigan Orthotics
& Prosthetics Center
Hi Kimberly,
I recognize your name, and I am pretty sure what side of this discussion you are on. I have been in the field of O&P for 28 years, a dinosaur by some standards. I first encountered the use of “client” in 1985 as it related to individuals in need of customized seating systems. It seemed foreign at the time but I gradually got used to it. The term “patient” is much more commonly used in O&P, and contrary to what some believe, it is not intended as a put-down or related to authority in any way. As a matter of fact, I hold the term patient to infer a higher status than that of client. But each to their own interpretation, acknowledging, as the world seems so fond of doing these days, the tendency to vilify colloquial terminology.
Maybe more to the point, an ethical O&P practitioner/provider/vendor (take your pick) will only see the person coming in the door with a prescription from their physician. When we refer to the “patient” it is correctly and with respect to the doctor/patient relationship that landed them in our office in the first place. Whatever verbiage lends itself to a respectful and beneficial relationship, be it practitioner/patient or vendor/client, then that’s preferred. I know which one I believe is more respectful, but the “customer” is always right!
Rick Miller, C.O.
Dear Kimberly,
I would like to offer my opinion on why I refer to my patients as patients not clients. I went to college to get a degree in Science (with a strong emphasis on the physical sciences associated with MEDICINE) and then to Northwestern University Medical School’s Prosthetic and Orthotic program. Northwestern’s O&P program falls under the realm of the Department of Orthopedic Surgery. I pay for Medical Malpractice Insurance and have to be credentialed to work in hospitals. My referral sources are Doctors, Physical Therapists, Nurses and other health care professionals.
I have worked hard to become a credentialed Medical Professional and serve the medical community. I think it is absurd that some people feel our patients are clients. I take very seriously the responsibility I have in taking care of a Doctor’s patient who has been referred to me.
Their status does not change from his door to mine. I am not a car mechanic, lawyer, or real estate agent that takes care of clients or customers. I take care of patients and that is a tremendous responsibility. We have to constantly monitor many health-related issues when dealing with our patients. We have to be aware of wound care, diabetic characteristics/sensitivities, vascular parameters, CPR, rescue breathing, read x-rays, and many other MEDICAL issues that pertain to patients not clients.
Rick Stapleton, CP
Dear Ms. Barreda,
I am a sole practitioner in my O&P facility. When I am under the care of a health practitioner I do not care what they call me, as long as I am treated with respect and good care.
As a person who works in this field, I do not like calling people by anything but their name. When I describe someone I work with to another “professional” I prefer to say something like, “this person I am working with....” or whatever.
I have found that if I use “patient” people think more highly of me, like I am a doctor. I am not comfortable with that; it is not accurate. I have been in the field for about twenty-four years and I work with people only, not categories or words or labels.
Don McGovern, CPO
Hi Kimberley,
Patients dislike the use of the word “patient” because (particularly with amputees) the medical treatment for the condition they had is over in their minds and often an episode worth putting behind them. I agree with this sentiment. I certainly do not feel like a patient getting treatment when I go to collect my glasses!
Bill
Ms. Barreda,
Using the term “clients” infers that our relationship is purely business and that I am selling them an appliance. Therefore I use the term “patient” as I am part of the healthcare team helping to rebuild their life after the loss of a limb.
Bill Arrowood, CP
I learned the term “client” while in nursing school 10 years ago. It was explained that this term better identified patients as active participants in their own healthcare decisions. I am a strong advocate of educating my patients and including them in the decision process. However, I find that our population is primarily older and prefers the term patient. They are comfortable and familiar with it. “Client” was not well received. So, I continue to treat my patients as clients and refer to them as patients. As long as you respect the person and make them a part of the process, terminology really does not matter. Political correctness is best reflected in one’s actions than in their choice of words.
Joan K. Cestaro, C.P.
RPI- Virginia
Dear Karen (sic),
A prosthesis or orthosis is part of the medical treatment of a person, in so much as it continues the healing and recovery process. Since it is necessary for the prosthetist and orthotist to do such things as take casts of body parts which can be particularly personal… it is important to create a more formal environment such as in a medical setting. We are held to the same rules of conduct as medical professionals are such as not having relationships with patients and conducting ourselves under a medical type ethical system.
Anonymous
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