25 Responses

  1. Jenni Prokopy - ChronicBabe
    Jenni Prokopy - ChronicBabe February 2, 2009 at 9:24 am | | Reply

    Amy, great post - interesting distinction. I've always tried to avoid the "patient" label when I can, because I think it diminishes the idea of the "person" who's experiencing chronic and/or acute health care issues. But I kind of agree with Manny that "health care consumer" puts focus on the financial side of care. I guess I lean toward "client," if I had to pick the word I'd most like to see used. That word indicates rights for both parties - folks who receive and give care - and a certain level of choice on the part of the recipient. In any case, it's something I'll be chatting about with my docs over the next few weeks!

  2. Scott K. Johnson
    Scott K. Johnson February 2, 2009 at 10:20 am | | Reply

    I too can see it from both sides. The way that the OC has opened us up to so many different points of view is something that I really, really enjoy. Thanks!

  3. Kim
    Kim February 2, 2009 at 10:52 am | | Reply

    Great points!

    When I tackled this in a post, one of the folks who commented noted that it might be good to put the titles in context, much like you did in this post.

    I think of my patients as patients because I am a care-giver, that is the definition of nursing, if I am caring for you during an acute illness, you are my patient.

    I am my physician's "patient" whether I am there for a well-check or for an acute illness. I don't feel diminished by the term, and at my age I have a few chronic conditions (high cholesterol, anyone?)

    But when I search the web for information on high blood pressure (another of my chronic ailments), I am a consumer of health care in as much as I am looking for information and becoming informed on what medications are available and what equipment is most accurate.

    I see the "patient" as a person who needs acute care or help coping with an acute disease, as in a hospital or presenting to an ER. If you come to my ER, you're my patient. If you come to my hospital to attend a diabetes seminar or classes, you're a client or health care "consumer".

    Every one of us is a health care consumer. Not all of us are patients. My husband has diabetes, he doesn't consider himself a patient unless he suddenly develops a need for acute care. We can have a chronic illness or condition, but that doesn't make us automatically "patients".

    The word "patient" is specific, IMO, and the relationship between "patient" and caregiver is unique and "client" or "health care consumer", when you are dealing in an acute setting just doesn't cut it, at least for me, speaking as a nurse.

    If you don't need direct "care" than you aren't a patient. Maybe it's that simple.

    I have been told that in community services, the preferred term is "client". I'll see what that feels like in the fall when I have my community health practicum. : )

  4. Manny Hernandez
    Manny Hernandez February 2, 2009 at 11:22 am | | Reply

    Maybe we need to come up with a new term that takes us away from both... :)

    I was chatting with one of our Advisors at the Diabetes Hands Foundation a while back. He mentioned the term "biocitizen" (I believe), which I have a bit of a hard time relating to. But at least it doesn't carry the connotations that consumer or patient may carry.

    In any case, great points, Amy! :)

  5. tmana
    tmana February 2, 2009 at 1:33 pm | | Reply

    We all receive health care; however, the current system places all decision-making (beyond the decision to seek care) in the hands of the insurers and of the care-givers, and the apparent cost squarely in the hands of the insurers.

    We are supposed to be "patient", waiting for their paternalistic proclamations of power over us. To them, we are but the guinea pigs (did I say that? I meant "gamma testers") for their latest concoctions, and paying pricily for the privilege.

    The Internet has made a lot more information -- both good and bad -- readily accessible to the intrepid individual interested in protecting and maintaining his (or her) physical health. With that information, we are more apt to question "authority", take an active role in our own care program, and complain about the comparative slowness with which solutions appear for our chronic conditions.

    Perhaps, we have moved from "consumers" and "patients" to something new: impatients. Which pretty much defines all consumers and customers with "issues".

  6. Marie Connelly
    Marie Connelly February 2, 2009 at 2:18 pm | | Reply

    Awesome post, Amy! Manny's blog post prompted me to write about this issue as well, though I looked at it more from the perspective of a Health2.0 site.

    I think you make a great point about what these words mean for people who are living with a chronic illness, it's not an either/or situation.

    I'd love to hear your thoughts on the phrase we came up with to try and bridge this gap: Health Activist. (

  7. “Patients” vs. “Health Care Consumers”? Both, If You Ask AmyT |

    [...] Tenderich weighs in on the name debate: patient vs. consumer. Almost anything is better than cyberchondriac or medical googler, but e-patient is still my [...]

  8. Jane Sarasohn-Kahn
    Jane Sarasohn-Kahn February 2, 2009 at 4:55 pm | | Reply

    Amy, great discussion about something I think about a lot these days. Let me add a third dimension to the patient/consumer label -- CITIZEN. I spent some time in the early 2000s with the wonderful Jean-Claude Healy in the European Community. Healy was an early e-Health pioneer. He was the one who taught me the word "citizen" in the context of e-patients. When you consider what's at stake these days in health reform -- covering the un- and under-insured, people getting access to expensive specialty drugs, ad nauseum -- citizenry is required for any engaged patient-consumer. Thanks for hosting this excellent dialogue. Your friend in the icy east coast, Jane S-K

  9. Lauren
    Lauren February 2, 2009 at 5:54 pm | | Reply

    How about taking profits out of the equation so we can all just be human beings? "Health care consumers" is not a term I like at all, as both a patient and a future health care provider. My patients are people. Their life and their health is as precious to them as my life and health are precious to me. Thinking of sick people as "consumers" is another way of detaching from the reality of human suffering.

    The core problem in our system is money. Doctors keep patients waiting because they triple-book 10-minute appointments. They are forced to practice cattle-car medicine by the demands of their clinic, or by overloaded hospitals and ERs, as insurance companies cut reimbursements, raise premiums, and enjoy astronomical profits. The long waits, the rushed visits, the hassle of dealing with the bureaucratic nonsense required for "reimbursement" creates an unequal relationship between doctor and patient, and unnecessarily complicates the efficient and empathetic delivery of health care. Why do we stand for it?

    Insurance companies are poison in our health care system, insofar as we have a "system" -- they are driven by greed and never by basic decency and humanity. I wonder how many insurance company CEOs would allow their own parents, spouses, and children to receive the sort of "health care" their company allows. For-profit health insurance is an abhorrent notion that has led to all sorts of nightmares. Let's get the middlemen out of the equation ( so patients and doctors can build a constructive relationship and together work toward the best health outcomes possible.

  10. Lee Ann Thill
    Lee Ann Thill February 2, 2009 at 6:38 pm | | Reply

    At the community mental health agency at which I used to work, and at many agencies within the mental health treatment world, consumer is the preferred term. With a chronic illness, be it physical or mental, overly identifying with being a patient - and thus being ill, needing treatment, being under a treatment provider's care, and all the implications that come with that role - can inform one's perception of self in a negative way. Maybe this isn't so much the case for an adult diagnosed later in life, but it can be especially damaging to the identity development of children and teens.

    in the end it's just semantics, but words come with meaning, connotations and associations that affect us, our perception and how we're perceived within our environment.

    As I said elsewhere regarding this issue, I don't necessarily like the connotations that come with being a life-long patient, but now I associate consumer with chronic serious mental illness because of what I do professionally, so I definitely don't care for that label either, even though it's supposed to suggest being empowered. Is being called diabetic an option because I think I far prefer that.

  11. Dennis
    Dennis February 2, 2009 at 8:54 pm | | Reply

    "in the end it’s just semantics,"

    Yes, I agree.. but I tell them I am your Client.. Customer as well..
    You don't do right by me and I sue you...

    Like Dr.'s Telling me that having a 7% A1c's is good and just keep your BG's btwn 110 and 150 and you'll do fine..taking Months if not longer to help one figure out Carb Counting, Developing a I:CR ( Insulin To Carb ratio) CB ( Correction Bolusing) and or one of my should do a CB at 1 or 2 hrs..even if your 300...

    Incompetence is rampid.. I see it at least once a week in the ADA's T1 Boards with people comming in with such MisInformation to just plain negligence by their Dr.'s..

    The Latest one? was never told how to count carbs and Use a I:CR method ( using the 500 rule) let alone how to do a fasting Basil Test to Using the 1500/1800 rule for figuring out your sensitivity factors,etc..

    And Of 6 Endo's I have had over the yrs at the VA? NONE admitted to Knowing anything about Dr. Bernsteins or 3 other Books..Using Insulin, Think like a Pancrease, etc...

    I send a copy of each to every New Dr. I get..and to their Nurses..
    along with a note " Please read by time I come in , in the next 3mos. so we can dicuss your Opinions and why I have 5.5% A1c's following whats in these Books.. if you haven't? I will have to change Dr.'s again..since we will not be on the same page" Thank you.

    And I have Sue some as well as some nurses and Nutritionist..

    On GP? Was more interested in selling me His Line of Vitamins and His Book on General Health.. and a Dermotologist? He tried to charge me $500 to remove a Mole that I had gotten a quote of only being $135 prior to comming in and after a examination... Only after Threatening to Sue and file Charges for Fraud did they drop it..

    Another Visit in the Hospital? They charged me $5 for everytime I tested My own BG's with my own Test Meter and Strips at 4 x a day.. ( i test 10x) found that the Nurse would put it down she did the testing...and would put in my Meter #'s....

    So, we are Patients, Clients and Customers all in one..

  12. Susannah Fox
    Susannah Fox February 3, 2009 at 6:50 am | | Reply

    Amy and everyone,

    I'm really interested in this discussion and I like Health Activist to describe the segment of the population that I've been calling "e-patients" (see or my health reports on "Activist" captures something that e-patients cannot: the often-large network of people who surround a patient, such as friends, family members, etc.

    Anything is better than cyberchondriac, in my opinion.


  13. Ken Oshan
    Ken Oshan February 3, 2009 at 2:53 pm | | Reply

    We are patients, medical consumers, but mostly we must wear the mantle of "medical clients", while healthcare providers must act as "medical consultants". This nuanced description implies that we will receive and act on the best professional advice available to us, musch as we would (hopefully) heed the best advice of our lawyer or accountant. There are rights and responsibilities for each party.

  14. Jorge de la Rosa
    Jorge de la Rosa February 3, 2009 at 8:55 pm | | Reply

    I just read your post and I liked it. As you know, we "customers" are very sensitized about the role of the pharmaceutical business circus. Out there is a cold, commercial world, a show run by the pharmacy trusts. I believe the best role the internet is playing is the one regarding information. There is no reason why anyone should be misinformed nowadays, and misinformation with the intent of profit is cruel and unjust. And intentional misinformation, like hiding part of the facts, is the weapon that this group wields to engross their bank accounts. There's just that part of society- the poor, the naive, and the elderly- on whom they always prey. Let's do our part in countering misinformation!

  15. David Collin
    David Collin February 6, 2009 at 12:48 pm | | Reply

    Semantics tends to show us where we have been. "Consumers" fits with the overall consumerist nature of our culture--now being challenged by the over-extension that contributes to our economic woes. "Patient" reflects the health culture in which the issue of health comes up mainly after we're sick.

    But what about a word that encompasses people who are health conscious and pro-active in preventing illness and staying well? I like Susannah's term "activist." At least it makes room for people who are actively living to prevent illness.

    I think one of the big challenges of the "e-patient" movement is to turn the thrust of its practices into a prevention, wellness-oriented movement. Online information and support Would be powerful there too, but it needs to come before we become either "patients" or "consumers."

  16. Should patients be treated as customers, and if so, are they always right? | Telecom News

    [...] diabetes blogger Amy Tenderich writes that being a consumer implies being a customer, as in, “the customer is always right.” But how realistic is that? When a patient [...]

  17. jeremiah
    jeremiah February 7, 2009 at 6:57 am | | Reply

    forget about these words e-patient, or health consumer, or everything else everyone has been screaming how about this word: universial, as in universal healthcare where a government shows that it cares about the well being of it's people instead of the current bankrupting of the american public. why should only a select few get to have the privilage of insurance when there are those as my self who can afford the best care but cannot even get a whiff of insurance in case something else non diabetes related where to happen to myself. as it stands right now i myself pay just for insulin, strips, and omnipods, looking out for the best deals and i am still paying over $20,000 dollars a year just for basic survival that is what is criminal

  18. Aggravated DocSurg
    Aggravated DocSurg February 7, 2009 at 10:30 am | | Reply

    I'm pretty sure that I graduated from medical school, not "provider school." I am a physician, and my job entails interacting with and caring for entities that are called patients. While this is indeed a business (going over budgets, employee evaluations, insurance contracts and the like at night after being on call drives that point home), it is a very different type of business than Home Depot. I think it is a disservice to call patients consumers, and I believe that is a very demeaning and condescending term. While a person indeed will often see themselves as a consumer --- for example, when deciding which hospital to use or which physician to see --- once the doctor-patient relationship is formed, they should be seen only as a patient.

  19. Bill Peckham
    Bill Peckham February 7, 2009 at 3:31 pm | | Reply

    Patient or Customer? Neither.
    Patient describes a business relationship too: I am only a patient when someone is getting paid. And the word patient carries baggage that comes from its meaning in regard to acute medicine; this acute baggage is inappropriate when referring to someone dealing with a chronic condition.

    We can do better than modeling ourselves after the players in a business transaction or the passive language of acute medicine. Living with a chronic disease takes far more effort than establishing a handful of business arrangements or just being informed of what the doctor thinks is best. We should look to the business language of partnership or affiliation rather than the language of the business transaction.

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  21. The Hard Sell | Diario BV
    The Hard Sell | Diario BV April 6, 2009 at 2:16 am |

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  22. Kevin Kruse at e-Patient Connections

    I'm late to this post but Susannah Fox sent me over and I'm glad she did. I, too, was curious about the definition and use of the terms e-patient versus empowered patient and health consumer and ran some simple Google counts on them. Also, according to survey research out there I've seen, like it or not, we ARE acting as health consumers; healthcare IS a consumer marketplace. Maybe we don't need to call "us" that, but it is the reality. For now, I'm sticking with the term e-patient and hope others adopt it more widely. My article, "What do you mean, e-patient?" is here:

  23. The Pew Internet/Health FAQ |

    [...] vs. cyberchondriacs. Amy Tenderich of DiabetesMine had another good take on this topic:  “Patients” versus “Health Care Consumers”? Both, If You Ask Me. We also unpacked a Microsoft study of “cyberchondria” (be sure to read the comments on [...]

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    [...] vs. cyberchondriacs. Amy Tenderich of DiabetesMine had another good take on this topic:  “Patients” versus “Health Care Consumers”? Both, If You Ask Me. We also unpacked a Microsoft study of “cyberchondria” (be sure to read the comments on [...]

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