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Dear Dr. Mossman,
At the multispecialty hospital where I work, administrators refer to patients as “customers” and tell us that, by improving “the customer experience,” we can reduce complaints and avoid malpractice suits. This business lingo offends me. Doesn’t providing good care do more to prevent malpractice claims than calling sick patients “customers”?
Submitted by “Dr. H”
“All words are pegs to hang ideas on.” As was true when Reverend Henry Ward Beecher uttered this phrase in the 19th century,1 names affect how we relate to and feel about people. Many doctors don’t think of themselves as “selling” services, and they find calling patients “customers” distasteful.
But for at least 4 decades, mental health professionals themselves have used a “customer approach” to think about certain aspects of psychiatrist–patient encounters.2 More pertinent to Dr. H’s questions, many attorneys who advise physicians are convinced that giving patients a satisfying “customer experience” is a sound strategy for reducing the risk of malpractice litigation.3
If the attorneys are right, taking a customer service perspective can lower the likelihood that psychiatrists will be sued. To understand why, this article looks at:
• terms for referring to health care recipients
• the feelings those terms generate
• how the “customer service” perspective has become a malpractice prevention
strategy.
Off-putting connotations
All the currently used ways of referring to persons served by doctors have off-putting features.
The word “patient” dates back to the 14th century and comes from Latin present
participles of pati, “to suffer.” Although Alpha Omega Alpha’s motto—“be worthy
to serve the suffering”4—expresses doctors’ commitment to help others, “patient”
carries emotional baggage. A “patient” is “a sick individual” who seeks treatment
from a physician,5 a circumstance that most people (including doctors) find unpleasant and hope is only temporary. The adjective “patient” means “bearing pains or trials calmly or without complaint” and “manifesting forbearance under provocation or strain,”5 phrases associated with passivity, deference, and a long wait to see the doctor.
Because “patient” evokes notions of helplessness and need for direction, non-medical psychotherapists often use “client” to designate care recipients. “Client” has the same Latin root as “to lean” and refers to someone “under the protection of another.” More pertinent to discussions of mental health care, a “client” also is “a person who pays a professional person or organization for services” or “a customer.”5 The latter definition explains what makes “client” feel wrong to medical practitioners, who regard those they treat as deserving more compassion and sacrifice than someone who simply purchases professional services.
“Consumer,” a word of French origin derived from the Latin consumere (“to take
up”), refers to “a person who buys goods and services.”5 If “consumers” are buyers, then those from whom they make purchases are merchants or sellers. Western marketplace concepts often regard consumers as sovereign judges of their needs, and the role of commodity producers is to try to satisfy those needs.6
The problem with viewing health care recipients this way is that sellers don’t caution customers about buying things when only principles of supply-and-demand govern exchange relationships.7 Quite the contrary: producers sometimes promote their products through “advertising [that] distorts reality and creates artificial needs to make profit for a firm.”8 If physicians behave this way, however, they get criticism and deserve it.
A “customer” in 15th-century Middle English was a tax collector, but in modern
usage, a customer is someone who, like a consumer, “purchases some commodity or service.”5 By the early 20th century, “customer” became associated with notions of empowerment embodied in the merchants’ credo, “The customer is always right.”9 Chronic illnesses often require self-management and collaboration with those labeled the “givers” and “recipients” of medical care. Research shows that “patients are more trusting of, and committed to, physicians who adopt an empowering communication style with them,” which suggests “that empowering
patients presents a means to improve the patient–physician relationship.”10
Feelings about names
People have strong feelings about what they are called. In opposing calling patients “consumers,” Nobel Prize-winning economist Paul Krugman explains: “Medical care is an area in which crucial decisions—life and death decisions—must be made; yet making those decisions intelligently requires a vast amount of specialized knowledge; and often those decisions must also be made under conditions in which the patient …needs action immediately, with no time for discussion, let alone comparison shopping. …That’s why doctors have traditionally…been expected to behave according to higher standards than the average professional…The idea that all this can be reduced to money—that doctors are just people selling services to consumers of health care—is, well, sickening.”11
Less famous recipients of nonpsychiatric medical services also prefer being called
“patients” over “clients” or “consumers.”12-14 Recipients of mental health services have a different view, however. In some surveys, “patient” gets a plurality or majority of service recipients’ votes,15,16 but in others, recipients prefer to be called “clients” or other terms.17,18 Of note, people who prefer being called “patients” tend to strongly dislike being called “clients.”19 On the professional
side, psychiatrists—along with other physicians—prefer to speak of treating “patients” and to criticize letting economic phrases infect medical discourse.20-22
Names: A practical difference?
Does what psychiatrists call those they serve make any practical difference? Perhaps not, but evidence suggests that the attitudes that doctors take toward patients affects economic success and malpractice risk.
When they have choices about where they can seek health care, medical patients value physicians’ competence, but they also consider nonclinical factors such as family members’ opinions and convenience.23 Knowing this, the federal government’s Centers for Medicare & Medicaid Services publishes results from its Hospital Consumer Assessment of Healthcare Providers and Systems to “create incentives for hospitals to improve their quality of care.”24
Nonclinical factors play a big part in patients’ decisions about suing their doctors, too. Many malpractice claims turn out to be groundless in the sense that they do not involve medical errors,25 and most errors that result in injury do not lead to malpractice suits.26
What explains this disparity? Often when a lawsuit is filed, whatever injury may have occurred is coupled with an aggravating factor, such as a communication gaffe,27 a physician’s domineering tone of voice,28 or failure to acknowledge error.29 The lower a physician’s patient satisfaction ratings, the higher the physician’s likelihood of receiving complaints and getting sued for malpractice.30,31
These kinds of considerations probably lie behind the recommendation of one hospital manager to doctors: “Continue to call them patients but treat them like
customers.”32 More insights into this view come from responses solicited from Yale
students, staff members, and alumni about whether it seems preferable to be a “patient” or a “customer” (Box).33
Bottom Line
When patients get injured during medical care, evidence suggests that how they feel about their doctors makes a big difference in whether they decide to file suit. If you’re like most psychiatrists, you prefer to call persons whom you treat “patients.” But watching and improving the things that affect your patients’ “customer experience” may help you avoid malpractice litigation.
Related Resource
• Goldhill D. To fix healthcare, turn patients into customers. Bloomberg Personal Finance. www.bloomberg.com/news/2013-01-03/to-fix-health-care-turn-patients-intocustomers.html.
Disclosure
Dr. Mossman reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
1. Beecher HW, Drysdale W. Proverbs from Plymouth pulpit. New York, NY: D. Appleton & Co.;1887.
2. Lazare A, Eisenthal S, Wasserman L. The customer approach to patienthood: attending to patient requests in a walk-in clinic. Arch Gen Psychiatry. 1975;32:553-558.
3. Schleiter KE. Difficult patient-physician relationships and the risk of medical malpractice litigation. Virtual Mentor. 2009;11:242-246.
4. Alpha Omega Alpha Honor Medical Society. Alpha Omega Alpha constitution. http://www.alphaomegaalpha.org/constitution.html. Accessed December 13, 2013. Accessed December 13, 2013.
5. Merriam-Webster. Dictionary. http://www.merriamwebster.com. Accessed December 9, 2013.
6. Kotler P, Burton S, Deans K, et al. Marketing, 9th ed. Frenchs Forest, Australia: Pearson Education Australia; 2013.
7. Deber RB. Getting what we pay for: myths and realities about financing Canada’s health care system. Health Law Can. 2000;21(2):9-56.
8. Takala T, Uusitalo O. An alternative view of relationship marketing: a framework for ethical analysis. Eur J Mark. 1996;30:45-60.
9. Van Vuren FS. The Yankee who taught Britishers that ‘the customer is always right.’ Milwaukee Journal. http://www.wisconsinhistory.org/wlhba/articleView.
asp?pg=1&id=11176. Published September 9, 1932. Accessed December 20, 2013.
10. Ouschan T, Sweeney J, Johnson L. Customer empowerment and relationship outcomes in healthcare consultations. Eur J Mark. 2006;40:1068-1086.
11. Krugman P. Patients are not consumers. The New York Times. http://krugman.blogs.nytimes.com/2011/04/20/patients-are-not-consumers. Published April 20, 2011. Accessed December 13, 2013.
12. Nair BR. Patient, client or customer? Med J Aust. 1998;169:593.
13. Wing PC. Patient or client? If in doubt, ask. CMAJ. 1997;157:287-289.
14. Deber RB, Kraetschmer N, Urowitz S, et al. Patient, consumer, client, or customer: what do people want to be called? Health Expect. 2005;8(4):345-351.
15. Sharma V, Whitney D, Kazarian SS, et al. Preferred terms for users of mental health services among service providers and recipients. Psychiatr Serv. 2000;51(2): 203-209.
16. Simmons P, Hawley CJ, Gale TM, et al. Service user, patient, client, user or survivor: describing recipients of mental health services. Psychiatrist. 2010;34:20-23.
17. Lloyd C, King R, Bassett H, et al. Patient, client or consumer? A survey of preferred terms. Australas Psychiatry. 2001; 9(4):321-324.
18. Covell NH, McCorkle BH, Weissman EM, et al. What’s in a name? Terms preferred by service recipients. Adm Policy Ment Health. 2007;34(5):443-447.
19. Ritchie CW, Hayes D, Ames DJ. Patient or client? The opinions of people attending a psychiatric clinic. Psychiatrist. 2000;24(12):447-450.
20. Andreasen NC. Clients, consumers, providers, and products: where will it all end? Am J Psychiatry. 1995;152:1107-1109.
21. Editorial. What’s in a name? Lancet. 2000;356(9248):2111.
22. Torrey EF. Patients, clients, consumers, survivors et al: what’s in a name? Schizophr Bull. 2011;37(3):466-468.
23. Wilson CT, Woloshin S, Schwartz L. Choosing where to have major surgery: who makes the decision? Arch Surg. 2007;142(3):242-246.
24. Centers for Medicare & Medicaid Services. Hospital consumer assessment of healthcare providers and systems. http://www.hcahpsonline.org. Accessed
January 26, 2014.
25. Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-2033.
26. Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence—results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245-251.
27. Huntington B, Kuhn N. Communication gaffes: a root cause of malpractice claims. Bayl Univ Med Cent. 2003;16(2):157-161.
28. Ambady N, Laplante D, Nguyen T, et al. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002;132(1):5-9.
29. Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996;156(22):2565-2569.
30. Stelfox HT, Gandhi TK, Orav EJ, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):
1126-1133.
31. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951-2957.
32. Bain W. Do we need a new word for patients? Continue to call them patients but treat them like customers. BMJ. 1999;319(7222):1436.
33. Johnson R, Moskowitz E, Thomas J, et al. Would you rather be treated as a patient or a customer? Yale Insights. http://insights.som.yale.edu/insights/would-you-rather-betreated-patient-or-customer. Accessed December 13, 2013.
Dear Dr. Mossman,
At the multispecialty hospital where I work, administrators refer to patients as “customers” and tell us that, by improving “the customer experience,” we can reduce complaints and avoid malpractice suits. This business lingo offends me. Doesn’t providing good care do more to prevent malpractice claims than calling sick patients “customers”?
Submitted by “Dr. H”
“All words are pegs to hang ideas on.” As was true when Reverend Henry Ward Beecher uttered this phrase in the 19th century,1 names affect how we relate to and feel about people. Many doctors don’t think of themselves as “selling” services, and they find calling patients “customers” distasteful.
But for at least 4 decades, mental health professionals themselves have used a “customer approach” to think about certain aspects of psychiatrist–patient encounters.2 More pertinent to Dr. H’s questions, many attorneys who advise physicians are convinced that giving patients a satisfying “customer experience” is a sound strategy for reducing the risk of malpractice litigation.3
If the attorneys are right, taking a customer service perspective can lower the likelihood that psychiatrists will be sued. To understand why, this article looks at:
• terms for referring to health care recipients
• the feelings those terms generate
• how the “customer service” perspective has become a malpractice prevention
strategy.
Off-putting connotations
All the currently used ways of referring to persons served by doctors have off-putting features.
The word “patient” dates back to the 14th century and comes from Latin present
participles of pati, “to suffer.” Although Alpha Omega Alpha’s motto—“be worthy
to serve the suffering”4—expresses doctors’ commitment to help others, “patient”
carries emotional baggage. A “patient” is “a sick individual” who seeks treatment
from a physician,5 a circumstance that most people (including doctors) find unpleasant and hope is only temporary. The adjective “patient” means “bearing pains or trials calmly or without complaint” and “manifesting forbearance under provocation or strain,”5 phrases associated with passivity, deference, and a long wait to see the doctor.
Because “patient” evokes notions of helplessness and need for direction, non-medical psychotherapists often use “client” to designate care recipients. “Client” has the same Latin root as “to lean” and refers to someone “under the protection of another.” More pertinent to discussions of mental health care, a “client” also is “a person who pays a professional person or organization for services” or “a customer.”5 The latter definition explains what makes “client” feel wrong to medical practitioners, who regard those they treat as deserving more compassion and sacrifice than someone who simply purchases professional services.
“Consumer,” a word of French origin derived from the Latin consumere (“to take
up”), refers to “a person who buys goods and services.”5 If “consumers” are buyers, then those from whom they make purchases are merchants or sellers. Western marketplace concepts often regard consumers as sovereign judges of their needs, and the role of commodity producers is to try to satisfy those needs.6
The problem with viewing health care recipients this way is that sellers don’t caution customers about buying things when only principles of supply-and-demand govern exchange relationships.7 Quite the contrary: producers sometimes promote their products through “advertising [that] distorts reality and creates artificial needs to make profit for a firm.”8 If physicians behave this way, however, they get criticism and deserve it.
A “customer” in 15th-century Middle English was a tax collector, but in modern
usage, a customer is someone who, like a consumer, “purchases some commodity or service.”5 By the early 20th century, “customer” became associated with notions of empowerment embodied in the merchants’ credo, “The customer is always right.”9 Chronic illnesses often require self-management and collaboration with those labeled the “givers” and “recipients” of medical care. Research shows that “patients are more trusting of, and committed to, physicians who adopt an empowering communication style with them,” which suggests “that empowering
patients presents a means to improve the patient–physician relationship.”10
Feelings about names
People have strong feelings about what they are called. In opposing calling patients “consumers,” Nobel Prize-winning economist Paul Krugman explains: “Medical care is an area in which crucial decisions—life and death decisions—must be made; yet making those decisions intelligently requires a vast amount of specialized knowledge; and often those decisions must also be made under conditions in which the patient …needs action immediately, with no time for discussion, let alone comparison shopping. …That’s why doctors have traditionally…been expected to behave according to higher standards than the average professional…The idea that all this can be reduced to money—that doctors are just people selling services to consumers of health care—is, well, sickening.”11
Less famous recipients of nonpsychiatric medical services also prefer being called
“patients” over “clients” or “consumers.”12-14 Recipients of mental health services have a different view, however. In some surveys, “patient” gets a plurality or majority of service recipients’ votes,15,16 but in others, recipients prefer to be called “clients” or other terms.17,18 Of note, people who prefer being called “patients” tend to strongly dislike being called “clients.”19 On the professional
side, psychiatrists—along with other physicians—prefer to speak of treating “patients” and to criticize letting economic phrases infect medical discourse.20-22
Names: A practical difference?
Does what psychiatrists call those they serve make any practical difference? Perhaps not, but evidence suggests that the attitudes that doctors take toward patients affects economic success and malpractice risk.
When they have choices about where they can seek health care, medical patients value physicians’ competence, but they also consider nonclinical factors such as family members’ opinions and convenience.23 Knowing this, the federal government’s Centers for Medicare & Medicaid Services publishes results from its Hospital Consumer Assessment of Healthcare Providers and Systems to “create incentives for hospitals to improve their quality of care.”24
Nonclinical factors play a big part in patients’ decisions about suing their doctors, too. Many malpractice claims turn out to be groundless in the sense that they do not involve medical errors,25 and most errors that result in injury do not lead to malpractice suits.26
What explains this disparity? Often when a lawsuit is filed, whatever injury may have occurred is coupled with an aggravating factor, such as a communication gaffe,27 a physician’s domineering tone of voice,28 or failure to acknowledge error.29 The lower a physician’s patient satisfaction ratings, the higher the physician’s likelihood of receiving complaints and getting sued for malpractice.30,31
These kinds of considerations probably lie behind the recommendation of one hospital manager to doctors: “Continue to call them patients but treat them like
customers.”32 More insights into this view come from responses solicited from Yale
students, staff members, and alumni about whether it seems preferable to be a “patient” or a “customer” (Box).33
Bottom Line
When patients get injured during medical care, evidence suggests that how they feel about their doctors makes a big difference in whether they decide to file suit. If you’re like most psychiatrists, you prefer to call persons whom you treat “patients.” But watching and improving the things that affect your patients’ “customer experience” may help you avoid malpractice litigation.
Related Resource
• Goldhill D. To fix healthcare, turn patients into customers. Bloomberg Personal Finance. www.bloomberg.com/news/2013-01-03/to-fix-health-care-turn-patients-intocustomers.html.
Disclosure
Dr. Mossman reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Dear Dr. Mossman,
At the multispecialty hospital where I work, administrators refer to patients as “customers” and tell us that, by improving “the customer experience,” we can reduce complaints and avoid malpractice suits. This business lingo offends me. Doesn’t providing good care do more to prevent malpractice claims than calling sick patients “customers”?
Submitted by “Dr. H”
“All words are pegs to hang ideas on.” As was true when Reverend Henry Ward Beecher uttered this phrase in the 19th century,1 names affect how we relate to and feel about people. Many doctors don’t think of themselves as “selling” services, and they find calling patients “customers” distasteful.
But for at least 4 decades, mental health professionals themselves have used a “customer approach” to think about certain aspects of psychiatrist–patient encounters.2 More pertinent to Dr. H’s questions, many attorneys who advise physicians are convinced that giving patients a satisfying “customer experience” is a sound strategy for reducing the risk of malpractice litigation.3
If the attorneys are right, taking a customer service perspective can lower the likelihood that psychiatrists will be sued. To understand why, this article looks at:
• terms for referring to health care recipients
• the feelings those terms generate
• how the “customer service” perspective has become a malpractice prevention
strategy.
Off-putting connotations
All the currently used ways of referring to persons served by doctors have off-putting features.
The word “patient” dates back to the 14th century and comes from Latin present
participles of pati, “to suffer.” Although Alpha Omega Alpha’s motto—“be worthy
to serve the suffering”4—expresses doctors’ commitment to help others, “patient”
carries emotional baggage. A “patient” is “a sick individual” who seeks treatment
from a physician,5 a circumstance that most people (including doctors) find unpleasant and hope is only temporary. The adjective “patient” means “bearing pains or trials calmly or without complaint” and “manifesting forbearance under provocation or strain,”5 phrases associated with passivity, deference, and a long wait to see the doctor.
Because “patient” evokes notions of helplessness and need for direction, non-medical psychotherapists often use “client” to designate care recipients. “Client” has the same Latin root as “to lean” and refers to someone “under the protection of another.” More pertinent to discussions of mental health care, a “client” also is “a person who pays a professional person or organization for services” or “a customer.”5 The latter definition explains what makes “client” feel wrong to medical practitioners, who regard those they treat as deserving more compassion and sacrifice than someone who simply purchases professional services.
“Consumer,” a word of French origin derived from the Latin consumere (“to take
up”), refers to “a person who buys goods and services.”5 If “consumers” are buyers, then those from whom they make purchases are merchants or sellers. Western marketplace concepts often regard consumers as sovereign judges of their needs, and the role of commodity producers is to try to satisfy those needs.6
The problem with viewing health care recipients this way is that sellers don’t caution customers about buying things when only principles of supply-and-demand govern exchange relationships.7 Quite the contrary: producers sometimes promote their products through “advertising [that] distorts reality and creates artificial needs to make profit for a firm.”8 If physicians behave this way, however, they get criticism and deserve it.
A “customer” in 15th-century Middle English was a tax collector, but in modern
usage, a customer is someone who, like a consumer, “purchases some commodity or service.”5 By the early 20th century, “customer” became associated with notions of empowerment embodied in the merchants’ credo, “The customer is always right.”9 Chronic illnesses often require self-management and collaboration with those labeled the “givers” and “recipients” of medical care. Research shows that “patients are more trusting of, and committed to, physicians who adopt an empowering communication style with them,” which suggests “that empowering
patients presents a means to improve the patient–physician relationship.”10
Feelings about names
People have strong feelings about what they are called. In opposing calling patients “consumers,” Nobel Prize-winning economist Paul Krugman explains: “Medical care is an area in which crucial decisions—life and death decisions—must be made; yet making those decisions intelligently requires a vast amount of specialized knowledge; and often those decisions must also be made under conditions in which the patient …needs action immediately, with no time for discussion, let alone comparison shopping. …That’s why doctors have traditionally…been expected to behave according to higher standards than the average professional…The idea that all this can be reduced to money—that doctors are just people selling services to consumers of health care—is, well, sickening.”11
Less famous recipients of nonpsychiatric medical services also prefer being called
“patients” over “clients” or “consumers.”12-14 Recipients of mental health services have a different view, however. In some surveys, “patient” gets a plurality or majority of service recipients’ votes,15,16 but in others, recipients prefer to be called “clients” or other terms.17,18 Of note, people who prefer being called “patients” tend to strongly dislike being called “clients.”19 On the professional
side, psychiatrists—along with other physicians—prefer to speak of treating “patients” and to criticize letting economic phrases infect medical discourse.20-22
Names: A practical difference?
Does what psychiatrists call those they serve make any practical difference? Perhaps not, but evidence suggests that the attitudes that doctors take toward patients affects economic success and malpractice risk.
When they have choices about where they can seek health care, medical patients value physicians’ competence, but they also consider nonclinical factors such as family members’ opinions and convenience.23 Knowing this, the federal government’s Centers for Medicare & Medicaid Services publishes results from its Hospital Consumer Assessment of Healthcare Providers and Systems to “create incentives for hospitals to improve their quality of care.”24
Nonclinical factors play a big part in patients’ decisions about suing their doctors, too. Many malpractice claims turn out to be groundless in the sense that they do not involve medical errors,25 and most errors that result in injury do not lead to malpractice suits.26
What explains this disparity? Often when a lawsuit is filed, whatever injury may have occurred is coupled with an aggravating factor, such as a communication gaffe,27 a physician’s domineering tone of voice,28 or failure to acknowledge error.29 The lower a physician’s patient satisfaction ratings, the higher the physician’s likelihood of receiving complaints and getting sued for malpractice.30,31
These kinds of considerations probably lie behind the recommendation of one hospital manager to doctors: “Continue to call them patients but treat them like
customers.”32 More insights into this view come from responses solicited from Yale
students, staff members, and alumni about whether it seems preferable to be a “patient” or a “customer” (Box).33
Bottom Line
When patients get injured during medical care, evidence suggests that how they feel about their doctors makes a big difference in whether they decide to file suit. If you’re like most psychiatrists, you prefer to call persons whom you treat “patients.” But watching and improving the things that affect your patients’ “customer experience” may help you avoid malpractice litigation.
Related Resource
• Goldhill D. To fix healthcare, turn patients into customers. Bloomberg Personal Finance. www.bloomberg.com/news/2013-01-03/to-fix-health-care-turn-patients-intocustomers.html.
Disclosure
Dr. Mossman reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
1. Beecher HW, Drysdale W. Proverbs from Plymouth pulpit. New York, NY: D. Appleton & Co.;1887.
2. Lazare A, Eisenthal S, Wasserman L. The customer approach to patienthood: attending to patient requests in a walk-in clinic. Arch Gen Psychiatry. 1975;32:553-558.
3. Schleiter KE. Difficult patient-physician relationships and the risk of medical malpractice litigation. Virtual Mentor. 2009;11:242-246.
4. Alpha Omega Alpha Honor Medical Society. Alpha Omega Alpha constitution. http://www.alphaomegaalpha.org/constitution.html. Accessed December 13, 2013. Accessed December 13, 2013.
5. Merriam-Webster. Dictionary. http://www.merriamwebster.com. Accessed December 9, 2013.
6. Kotler P, Burton S, Deans K, et al. Marketing, 9th ed. Frenchs Forest, Australia: Pearson Education Australia; 2013.
7. Deber RB. Getting what we pay for: myths and realities about financing Canada’s health care system. Health Law Can. 2000;21(2):9-56.
8. Takala T, Uusitalo O. An alternative view of relationship marketing: a framework for ethical analysis. Eur J Mark. 1996;30:45-60.
9. Van Vuren FS. The Yankee who taught Britishers that ‘the customer is always right.’ Milwaukee Journal. http://www.wisconsinhistory.org/wlhba/articleView.
asp?pg=1&id=11176. Published September 9, 1932. Accessed December 20, 2013.
10. Ouschan T, Sweeney J, Johnson L. Customer empowerment and relationship outcomes in healthcare consultations. Eur J Mark. 2006;40:1068-1086.
11. Krugman P. Patients are not consumers. The New York Times. http://krugman.blogs.nytimes.com/2011/04/20/patients-are-not-consumers. Published April 20, 2011. Accessed December 13, 2013.
12. Nair BR. Patient, client or customer? Med J Aust. 1998;169:593.
13. Wing PC. Patient or client? If in doubt, ask. CMAJ. 1997;157:287-289.
14. Deber RB, Kraetschmer N, Urowitz S, et al. Patient, consumer, client, or customer: what do people want to be called? Health Expect. 2005;8(4):345-351.
15. Sharma V, Whitney D, Kazarian SS, et al. Preferred terms for users of mental health services among service providers and recipients. Psychiatr Serv. 2000;51(2): 203-209.
16. Simmons P, Hawley CJ, Gale TM, et al. Service user, patient, client, user or survivor: describing recipients of mental health services. Psychiatrist. 2010;34:20-23.
17. Lloyd C, King R, Bassett H, et al. Patient, client or consumer? A survey of preferred terms. Australas Psychiatry. 2001; 9(4):321-324.
18. Covell NH, McCorkle BH, Weissman EM, et al. What’s in a name? Terms preferred by service recipients. Adm Policy Ment Health. 2007;34(5):443-447.
19. Ritchie CW, Hayes D, Ames DJ. Patient or client? The opinions of people attending a psychiatric clinic. Psychiatrist. 2000;24(12):447-450.
20. Andreasen NC. Clients, consumers, providers, and products: where will it all end? Am J Psychiatry. 1995;152:1107-1109.
21. Editorial. What’s in a name? Lancet. 2000;356(9248):2111.
22. Torrey EF. Patients, clients, consumers, survivors et al: what’s in a name? Schizophr Bull. 2011;37(3):466-468.
23. Wilson CT, Woloshin S, Schwartz L. Choosing where to have major surgery: who makes the decision? Arch Surg. 2007;142(3):242-246.
24. Centers for Medicare & Medicaid Services. Hospital consumer assessment of healthcare providers and systems. http://www.hcahpsonline.org. Accessed
January 26, 2014.
25. Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-2033.
26. Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence—results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245-251.
27. Huntington B, Kuhn N. Communication gaffes: a root cause of malpractice claims. Bayl Univ Med Cent. 2003;16(2):157-161.
28. Ambady N, Laplante D, Nguyen T, et al. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002;132(1):5-9.
29. Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996;156(22):2565-2569.
30. Stelfox HT, Gandhi TK, Orav EJ, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):
1126-1133.
31. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951-2957.
32. Bain W. Do we need a new word for patients? Continue to call them patients but treat them like customers. BMJ. 1999;319(7222):1436.
33. Johnson R, Moskowitz E, Thomas J, et al. Would you rather be treated as a patient or a customer? Yale Insights. http://insights.som.yale.edu/insights/would-you-rather-betreated-patient-or-customer. Accessed December 13, 2013.
1. Beecher HW, Drysdale W. Proverbs from Plymouth pulpit. New York, NY: D. Appleton & Co.;1887.
2. Lazare A, Eisenthal S, Wasserman L. The customer approach to patienthood: attending to patient requests in a walk-in clinic. Arch Gen Psychiatry. 1975;32:553-558.
3. Schleiter KE. Difficult patient-physician relationships and the risk of medical malpractice litigation. Virtual Mentor. 2009;11:242-246.
4. Alpha Omega Alpha Honor Medical Society. Alpha Omega Alpha constitution. http://www.alphaomegaalpha.org/constitution.html. Accessed December 13, 2013. Accessed December 13, 2013.
5. Merriam-Webster. Dictionary. http://www.merriamwebster.com. Accessed December 9, 2013.
6. Kotler P, Burton S, Deans K, et al. Marketing, 9th ed. Frenchs Forest, Australia: Pearson Education Australia; 2013.
7. Deber RB. Getting what we pay for: myths and realities about financing Canada’s health care system. Health Law Can. 2000;21(2):9-56.
8. Takala T, Uusitalo O. An alternative view of relationship marketing: a framework for ethical analysis. Eur J Mark. 1996;30:45-60.
9. Van Vuren FS. The Yankee who taught Britishers that ‘the customer is always right.’ Milwaukee Journal. http://www.wisconsinhistory.org/wlhba/articleView.
asp?pg=1&id=11176. Published September 9, 1932. Accessed December 20, 2013.
10. Ouschan T, Sweeney J, Johnson L. Customer empowerment and relationship outcomes in healthcare consultations. Eur J Mark. 2006;40:1068-1086.
11. Krugman P. Patients are not consumers. The New York Times. http://krugman.blogs.nytimes.com/2011/04/20/patients-are-not-consumers. Published April 20, 2011. Accessed December 13, 2013.
12. Nair BR. Patient, client or customer? Med J Aust. 1998;169:593.
13. Wing PC. Patient or client? If in doubt, ask. CMAJ. 1997;157:287-289.
14. Deber RB, Kraetschmer N, Urowitz S, et al. Patient, consumer, client, or customer: what do people want to be called? Health Expect. 2005;8(4):345-351.
15. Sharma V, Whitney D, Kazarian SS, et al. Preferred terms for users of mental health services among service providers and recipients. Psychiatr Serv. 2000;51(2): 203-209.
16. Simmons P, Hawley CJ, Gale TM, et al. Service user, patient, client, user or survivor: describing recipients of mental health services. Psychiatrist. 2010;34:20-23.
17. Lloyd C, King R, Bassett H, et al. Patient, client or consumer? A survey of preferred terms. Australas Psychiatry. 2001; 9(4):321-324.
18. Covell NH, McCorkle BH, Weissman EM, et al. What’s in a name? Terms preferred by service recipients. Adm Policy Ment Health. 2007;34(5):443-447.
19. Ritchie CW, Hayes D, Ames DJ. Patient or client? The opinions of people attending a psychiatric clinic. Psychiatrist. 2000;24(12):447-450.
20. Andreasen NC. Clients, consumers, providers, and products: where will it all end? Am J Psychiatry. 1995;152:1107-1109.
21. Editorial. What’s in a name? Lancet. 2000;356(9248):2111.
22. Torrey EF. Patients, clients, consumers, survivors et al: what’s in a name? Schizophr Bull. 2011;37(3):466-468.
23. Wilson CT, Woloshin S, Schwartz L. Choosing where to have major surgery: who makes the decision? Arch Surg. 2007;142(3):242-246.
24. Centers for Medicare & Medicaid Services. Hospital consumer assessment of healthcare providers and systems. http://www.hcahpsonline.org. Accessed
January 26, 2014.
25. Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-2033.
26. Localio AR, Lawthers AG, Brennan TA, et al. Relation between malpractice claims and adverse events due to negligence—results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245-251.
27. Huntington B, Kuhn N. Communication gaffes: a root cause of malpractice claims. Bayl Univ Med Cent. 2003;16(2):157-161.
28. Ambady N, Laplante D, Nguyen T, et al. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002;132(1):5-9.
29. Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996;156(22):2565-2569.
30. Stelfox HT, Gandhi TK, Orav EJ, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118(10):
1126-1133.
31. Hickson GB, Federspiel CF, Pichert JW, et al. Patient complaints and malpractice risk. JAMA. 2002;287(22):2951-2957.
32. Bain W. Do we need a new word for patients? Continue to call them patients but treat them like customers. BMJ. 1999;319(7222):1436.
33. Johnson R, Moskowitz E, Thomas J, et al. Would you rather be treated as a patient or a customer? Yale Insights. http://insights.som.yale.edu/insights/would-you-rather-betreated-patient-or-customer. Accessed December 13, 2013.