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Changing relationships between people and providers: making sense of patient centred health care
  1. T Smith
  1. Senior Policy Analyst, Health Policy & Economic Research Unit, British Medical Association, London WC1H 9JR, UK; tsmith@bma.org.uk

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    In broad terms the development of policy seems to transcend national boundaries and health systems, at least in the developed world. For example, in England at present the emphasis is on “patient centred care” and, although this label may differ in other countries, some of its key elements will be recognisable elsewhere: aims to enhance the capacity of individuals for self-care; moving care out of hospitals and into communities in which patients live; and the development of care pathways that cross institutional and professional boundaries.

    A common theme runs through these elements—namely, the changing relationship between people and providers. The word “people” is used because one of the questions we must ask is whether the traditional term “patient” should remain in use, given that some see within it an inherent inequality between “patient” and “provider”. This question is central to the first paper written by researchers from Toronto.

    Empowering patients

    Is the term “patient” still appropriate when policy aims to place those seeking care on an equal footing with those delivering it? ▸

    The literature shows that the terminology used to describe individuals who come into contact with health services is problematic. This is more the case in some care areas than others and in mental health, for example, “the historical power imbalance has led some to reject the term patient”.

    The paper contains an interesting discussion of the derivation of various terms. Although there is no explicit reference to deference in the term “patient”, its Latin derivation means “to suffer”. While traditionally understood as “an individual awaiting or under medical care and treatment”, it can also be defined as “the capacity to tolerate delay, trouble or suffering without becoming angry or upset”.

    For those who seek health advice but are not ill, perhaps “patient” is not the best term. So what are the alternatives? Healthcare systems requiring people to pay for their care may encourage people to see themselves as consumers. But like “customer”—which …

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