Communication skills are essential to the dietitian’s and nutritionist’s tool kit. Communicating appropriately and respectfully can build the rapport vital for a successful working relationship. Here, Siân Cunningham RD, Assistant Professor in Dietetics at University of Nottingham, discusses the implications of the 'labels' used by healthcare professionals for those accessing clinical services. 

Healthcare professionals are moving away from the traditional medical model of "I say, you do" and a person-centred approach has been adopted throughout the healthcare system. This takes into account the preferences, needs and values of any individual accessing the service and aims to provide personalised care and treatment.¹

Language plays a key role in person-centred care and can demonstrate our intention to show respect for the autonomy and individuality of the person we are working with. A challenge for the healthcare professional is how we should be referring to the people who use our services, and with a range of terms to choose from, it can be hard to know which is best!

Commonly used terms include:

• Patient
• Client
• Service user

Other terms include:

• Survivor
• User
• Consumer

WHO USES WHAT?

As a (very) general rule, ‘patient’ is often used when people are actively receiving treatment and both the General Medical Council and The Royal College of Psychiatry make use of this term in official documents.

‘Service user’ may be more frequently used in services such as mental health, learning disabilities and social care.

‘Client’ (in dietetics) may once have been more common in the private sector but is used frequently by other professions such as Occupational Therapy and Social work.

SO, WHAT ARE SOME OF THE ISSUES?

It’s likely that each healthcare professional will have a personal preference and rationale for liking or disliking any of the options, and it seems at times we struggle to reach a consensus. Certainly, in clinical practice, all three terms are used interchangeably, both in verbal and written communication. Review of the National Service Framework for Mental Health found ‘service user’ 48 times, ‘patient’ 12 times and ‘client’ twice.²

Neuberger & Tallis explain that ’patient’ comes from the Latin ‘to suffer’.³ The word patient could imply that the person (or patient) follows the instructions of the healthcare provider and waits ‘patiently’ (and passively) to get better.³

‘Service user’ or ‘user’ are terms many healthcare professionals dislike because they involve using the service the person ‘uses’ to define them, removing individual identity.

Both ‘client’ and ‘consumer’ may carry connotations around ‘payment’ for services, at odds with the NHS being free at the point of access. More generally, any ‘label’ carries with it the risk of people being treated as one homogenous group.

DO WE NEED A ‘LABEL’ AT ALL?

As healthcare professionals we need some form of terminology to refer to the people who access our services, particularly for service planning discussions and policy documents. Whilst healthcare professionals are all experts at weighing up the pros and cons of any aspect of healthcare (making for great clinical judgement!), ultimately, we need to better understand what people accessing healthcare services want, and how being referred to by the different terms might positively or negatively impact on them.

WHAT DOES THE RESEARCH AND GUIDANCE SAY?

A recent scoping review published in The British Medical Journal found that, overall, healthcare recipients appear to prefer the term 'patient', but concluded that knowledge of an individual’s preference should always take precedence.⁴

A search of recently updated NICE guidance found ‘patient’ nine times and no use of ‘service user’ or ‘client’, with frequent use of the word ‘people’ (which appears 143 times) and opting for terms such as ‘people using services’.⁵

CONCLUSION

Clearly, the terminology we use does matter. Most importantly we need to demonstrate to people accessing our services the single most important aspect of communication: that we are listening! Just as we would be respectful of a person’s preferred name and their pronouns, we must consider the terminology that we use when talking about people who access services, and if we are not sure what is preferred, we can always ask!

The simple act of showing interest in someone else’s opinions can go a long way to making people feel valued. So, next time you hold feedback sessions or send out a survey, find out the terms that people prefer, the results might just surprise you!

Siân Cunningham RD MSc AFHEA
Assistant Professor in Dietetics, University of Nottingham

Siân has been working as a dietitian for over a decade,
currently lecturing in Dietetics, leading on communication skills training.
Previously, she worked in a range of clinical areas specialising in learning disabilities,
palliative care and nutritional support including HEN.
Siân is passionate about Co-production! She is a member of the MHSG,
and Education Officer for the newly established LD Sub-Group.

Twitter@:@siancunningham2

 References

1. NHS Health Education England, Person-centred care. https://www.hee.nhs.uk/our-work/person-centred-care [accessed 10th August 2022]
2. Simmons P, Hawley C, Gale T and Sivakumaran T (2010). Service user, patient, client, user or survivor: Describing recipients of mental health services The Psychiatrist, 34(1), 20-23
3. Neuberger J. Do we need a new word for patients? Let's do away with ‘patients’. BMJ 1999; 318: 1756-8
4. Costa DSJ, Mercieca-Bebber R, Tesson S. Patient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings. BMJ Open 2019
5. National Institute for Health Care and Excellence (NICE). Type 2 diabetes in adults: management, NICE guidelines [NG28]. Published: 02 December 2015 Last Updated: 29 June 2022