“Use your words,” we say to our children when they are young. “Choose your words carefully,” we say to them as they grow. Words are used in the most common modes of communication, spoken and written. Words have specific meaning and, frequently, words are taken out of context.
As healthcare continues to evolve, there are two words that have begun to be used interchangeably: patient and person. Though the difference between them might seem trite, there is a specific connotation to each. According to Merriam-Webster, a patient (n) is, “a sick individual especially when waiting or under the care and treatment of a physician or surgeon,” and a person (n) is, “a human being considered as an individual.” Interestingly, there is a link between these two words within their definitions, but there is also a discrete distinction.
According to Judeo-Christian beliefs, human beings are to be treated with respect and dignity because they are made in the image of God. To be in right relationship with God, we must be in right relationship with our fellow human beings. As the definition of “person” states, a person is a human being considered as an individual, and the word “individual” is the link between a person and a patient. But, when we look at the meaning of patient, there is another key component: being sick and awaiting or under the care of treatment. Therefore, all patients should be treated as persons, given dignity and respect, as they are human beings, but not all persons should be treated as patients.
Managing patients vs. persons
This focus on dignity and respect creates a framework of how we should engage, include, and treat (in the nonclinical context) people, meeting them where they are and being reverent to their holistic needs and environmental concerns. Though healthcare attempts to speak to this, we still seem to think of patients in a different light. We focus on patients from a biomedical, disease-based approach. That method might be completely appropriate from the perspective of diagnosing and treating when someone is quite ill, but can fall woefully short when managing the personal aspect. And it’s rarely just the patient who is suffering from their illness. Their “community” is also impacted, and these loved ones are persons, not patients.
Managing the “person” is important. Health status improvement, population health, wellness, and preventive care should be focused on the person. Our health insurance is moving towards high-deductible plans, which put more emphasis on personal decisions, and our metrics are shifting towards person-based metrics such as shared decision making, and feeling a part of healthcare treatment. People are becoming more involved in their healthcare, and consumerism is driving the person-centered concept.
Healthcare providers need to remember the definitions of these words and begin to think about those that we serve within the different contexts. If we want to engage persons, meeting them where they are, we need to shift our thinking away from seeing them as patients. While we treat patients, we must remember to treat them and their families as persons. As we design care models, focusing on both these concepts becomes our imperative. As an individual moves through their life, they move in and out of the distinctions discussed above.
A change in language is not a change in practice
We have begun to shift our language in order to try to “personalize” the aspect of being sick, such as using “person-centered” care versus “patient-centered” care, but they are not the same. When I am sick, I want to be treated as a patient, but as an engaged healthcare user, which includes many times when I am not sick, I do not want to be treated as a patient. As we move to value models and population health, those we serve will be a member of a “panel” of lives we are to manage versus individuals that need episodic care. Therefore we need to be attuned to care models that address this difference between person and patient. The Patient Centered Medical Home falls into this trap within its title. As a patient, coming to an office for care and getting all that I need is palatable, but as a person the concept of my medical home being centered on a location makes much less sense. As a person, my home is where I am, not where you, the healthcare system is. Should we change the words to Person Centered Medical Homes? Is “personalized” medicine focused on us as a patient or on us as a person?
Regardless of the term selected, we must be very mindful not only how they are used, but more importantly how we think about them. As those that deliver care, and are focused on managing populations, being aware of these differences will help us create models and mind sets that both treat patients as persons, and support the well-being of persons as persons.