Hello, Dr. Papanikolaou, and thank you for your question.

As far as I know, the term "consumer" was first used by Hunt el al. (2015). As they argue:

"Rather than patients per se [...] a consistent emphasis on ‘choice’ reflects a discourse of health consumerism that frames the public as self-motivated health consumers, voluntarily seeking out ways to improve their own health" (Hunt et al. 2015, p.5).

Of course, the context is quite specific: online health and SNSs, on one hand, UK regulation policies, on the other. These policies, of course, are related with the fact that:

"rather that directly providing web-based services through the National Health Service (NHS) to support patients with long-term health problems, the UK government defines its own role as 'stimulating a market' (Hunt & Koteyko 2015, p.446).

So, the term "healthcare services consumer" is related with a market model of economy in healthcare (thus, one can argue, with neoliberalism); in that sense, it's neither identical, neither interchangeable with the (neutral, at least in that sense) term "user".

Please, note here that, despite the (valid, on my opinion) arguments they present, Hunt et al. (2015) accompany the term with a question-mark. In other words, it's still an open debate.

Based on the above, and given the vast reforms of healthcare systems in both Greece and Cyprus (pushed mainly by the financial crisis, and the agreed memoranda), with the introduction, at least in Cyprus, of elements of a (quasi-) market model, we also decided to use the same term, again with a question-mark.

References 

Hunt D, Koteyko N (2015). 'What was your blood sugar reading this morning?' Representing diabetes self-management on Facebook. Discourse & Society, 26(4):445-463 [DOI:10.1177/0957926515576631].

Hunt D, Koteyko N, Gunter B (2015). UK policy on social networking sites and online health: From informed patient to informed consumer? Digital Health, 0(0):1–12 [DOI: 10.1177/2055207615592513].

The literature on applied healthcare seems to use a few different terms for those who use healthcare services: patient; user; consumer...; indeed, in my recent research-site, 'customer' was the preferred usage.

I have come to think that the term used is a function of practitioners' perspectives on how proactive they see users of healthcare to be.

Are these users content to be 'done to'? Or do they prefer to be 'done with' (have active participatory engagement with their healthcare)?

Although Hunt et. al. Used the term in 2015, the term was commonly utilized in the "corporate speak" in the mid-80's. There had been a big focus on internal and external "customers" in nursing administration meetings (in the US). External customers were the patients. In a healthcare system where there is choice and competition for patients, the term "customer" applies in that dynamic. In a system where there is no choice (I.e. Cuba) user may be more descriptive. So, my answer, would depend upon one's perspective specific to health delivery system.

Thank you for your answer, Philip Adams, and Christopher A Smith.

Indeed, consumer and (external) customer are terms related with a market system.

Internal customer is a term used mainly for describing the human resources/ employees of an organisation, seen from a human resources management/ employee satisfaction/ quality management point of view.

Absolutely not. We are talking about medicine and healthcare. The care of the sick is a human endeavour with a moral character. The use of commercial terminology is therefore inappropriate and creates a false context of transactionalism. Similarly, the words 'client' and 'customer' and 'service user' are to be excluded. Only lawyers and prostitutes have clients and customers and users. The humour employed here is deliberate, to make a point vividly. There is nothing wrong with the word 'patient'. It does not, contrary to some discourse, even from patients themselves, create asymmetry and power differential in the consultation. Etymologically it is derived from the Latin patiens, meaning he who suffers. If we do not understand the state and meaning of suffering and the phenomenology of the person who experiences it then we cannot do good medicine and medicine becomes reduced to the technical application of procedures and pharmacology. In research, we should use the word participant or patient, depending on the characteristics of the person involved. Participant is particularly appropriate because the person involved is co-creating new knowledge with the person conducing the research, research which should always be altruistic in nature and designed, ultimately, to lead to discoveries which collectively are conceived and aimed at relieving suffering. At the European Society for Person Centered Healthcare and in the Society's journal, the European Journal for Person Centered Healthcare, we do not allow consumerist terminology as a matter of ethical principle. It is too easy, in a world obsessed with consumerism and transaction, to allow medicine and healthcare to become polluted with the terminology of the marketplace and we should guard against it at all times. So called progressivists may not agree with what has been written here, but all those who find resonance with what is written are cordially invited to write to me and to join the Society to contribute to our work. 

Professor Andrew Miles MSc MPhil PhD DSc (hc), Senior Vice President and Secretary General, European Society for Person Centered Healthcare & Editor-in-Chief, European Journal for Person Centered Healthcare / Editor-in-Chief,  Journal of Evaluation in Clinical Practice. 

Therefore, the individual (or her/his representative) seeking care, across the entire spectrum of healthcare services is unable to make the choice between one form of care services and another one, is that right?

I don't quite understand the question. For sure, choice is fundamental. We cannot compromise a patient's autonomy by directing treatment, but rather by engaging actively with the patient through shared decision-making, a relatively modern approach which respects the clinician;s professionalism and the patient's autonomy. Clearly, in publicly funded health services, the decision-making takes place within the context of resource constraints, though patient and public involvement/engagement (PPI/E) are vital in working with politicians and policymakers to modify existing services or create new ones and to mediate the availability of new treatments. Within this framework, it is vital to understand that the patient is not a consumer and the clinician is not a supplier of goods. At the centre of care, as in person-centered care, there are two people, not one. The patient is accompanied by the clinician and both have rights and responsibilities.

@Andrew Miles. I can not disagree with you because I am in altruistic agreement. That being said, your premise is not the world that we live and practice in. We all suffer from the human condition and therefore fall short of the altruistic goal.

The harsh reality (this side of the pond) is that between patient satisfaction based reimbursement and a sense of entitlement among an ever enlarging portion of our patient population, we are stuck with service related terminology. 

I believe this dilemma is what led to Michail's original question. 

Thank you for your participation in this thread. It would be my pleasure to meet over a pint and discuss this topic until the management throws us out. Regards.

"The term 'patient' is also not appropriate in my opinion in terms of policy-making, because it focuses on the medical perspective and neglects the social one"

Many thanks for this. I would point out that the patient exists in a societal environment as well as a clinical one. A patient is a patient whether in clinic or at home, as home-based care becomes a rapidly emerging new healthcare context, as pioneered by such organisations as Healthcare At Home, an account of which appears in 5.1 of the European Journal for Person Centered Healthcare in late February 2017.  The patient is in an I - Thou relationship, as illustrated by Martin Buber, an Essay on which gained the European Society for Person Centered Healthcare's Essay Prize in September this year. The brochure is attached. A patient is a patient, whether in a clinical or social context and my view is that we should call things by their proper, appropriate and adequately descriptive names. In my earlier post I noted that some 'progressivists' would object to my view and that is absolutely fine, we need debate. But my view and that of the Society is very clear and it is set out here. Commercial language pollutes medicine and healthcare and the policymaking that impacts upon it, it is as simple as that and serves no useful or moral purpose. Rather, it distorts the historic mission and nature of medicine and healthcare. Neither can we divorce health policymaking and medical sociology from the precepts advanced here, to do so would be wrong and decontextualizing. 

@Andrew Miles. Is it not a dichotomy that you champion the term "patient" but you are associated with the European Society fo "Person" Centered Healthcare. Again, I agree with your position and premise. I refused to refer to patients as clients, customers or users. I just find you are not immune by association. Please keep the fight up. We care for patients! Whether others label them x or y.

@Eleni Koutsogeorgou

Perhaps you have right, and perhaps the correct term, regarding NHS, is, or should be "user". However, the UK goverment, cited by Hunt & Koteyko (2015), has a policy for "stimulating a market". That almost automatically brings "consumers" on board, and raises questions.

Moreover, even if a direct financial-based interaction isn't present in some healthcare systems, it's present in some others (America, America!!! but also Cyprus, where at least 20% of the population isn't covered by the public healthcare subsystem, thus covering their needs through the private healthcare subsystem, paid via private health insurance, or out-of-pocket payments); and, in any way, an indirect financial-based interaction is present (via social health insurance schemes, private for-profit and nonprofit health insurance companies, competition-based national health budget distribution models, quasi-market models, etc.) in (almost ?) all healthcare systems.

@Andrew Miles

Quite passionate (and absolute) your writing!!!

Being a RN (active in clinical practice), I understand your point. Indeed, there's nothing wrong with the word patient, if someone is a patient (as is the case in our project, cause we're focusing on chronic patients, mainly with diabetes and cancer), and if the word is used in the right context.

On the other hand, health services aren't just for patients. Would you call a pregnant woman a patient? Would you call a child receiving vaccination a patient? Would you call an otherwise healthy man participating in a stop-smoking programme a patient?

Furthermore, I have to remind here that this project is originally conducted in Greek, and we examine new behaviours in the Greek-speaking Facebook. In both ancient and modern Greek there are different words for patient:

1. πάσχων (páschon) is perhaps the most correct in terms of translation (etymologically related with pathology, originally meaning "the study of passion", i.e. the study of suffering, of being in pain), but is also quite archaic and used nowadays almost exclusively in medical and nursing textbooks, in Christian theology, and poetry;

2. νοσών (nosón), etymologically related to nosocomial, referring mainly to the existence of a νόσος (nósos), a disease;

3. ασθενής (asthenís), literally meaning without σθένος (sthénos), power and courage;

4. άρρωστος (árrostos), literally meaning without ρώμη (rómi), (physical) power and strength;

the last two words are the ones mainly used in modetn Greek, while for chronic patients almost exclusively the third one (asthenís).

What I'm trying to say here is that if we try to employ an etymology-based terminology, or if we accept or reject terms based solely on etymology, then we might face a great problem in Greek (that might be true in other languages, English including): an empowered patient in Greek translates as ενδυναμωμένος ασθενής (endinamoménos asthenís), which literally means "an empowered human without power and courage" :) . Of course, everybody understands that ασθενής shouldn't be taken literally, based on its etymology.

That being said, I have to make clear that this project isn't about medical research, it's about health policy research, in other words we have to comply with (but also question) the current terminology used in the field of health policy. Like it or not, this is a field vastly influenced by the fields of political sciences, economics, management, and, yes, marketing (unless one can give serious evidence that pharmaceutical or biotechnology corporations don't exist).

As Christopher A Smith noted above (and thank you for your answer), in the fields of health policy and health management we are sometimes stuck with services-related terminology. That's not always bad. In countries like Greece and Cyprus, with high levels of functionalism among the public servants/ employees, including in some cases physicians, nurses, and  other healthcare services staff, how can we improve the services provided if not by changing the mentallity that wants the patient to be just a patient, someone without power, or the user to be just a user, and by realising that this is actually a client, a customer, even a consumer, who has (indirectly, indeed) paid for the services provided?

Last, but not least, and to the extend I can speak on behalf of all its contributors, I have to make clear that it isn't the intention of this project to promote the use of market-related terms in healthcare; we just collect data, make observations, and question things under the light of new evidence and existing literature.

I apologise for my MSc thesis being in Greek, but, the ones that understand the language can read my criticism towards not only the term "consumer", but also towards the other term used, "biological citizen". I translate here a small part (pp.78-80 of the original text):

"The emerging behaviour of a biological citizen is [...] mainly an individual and not a collective behaviour, a behaviour related more with neo-liberalism, as a socio-political ideology [...].

Thus, the biological citizen is mainly an individual quality, an individual behaviour; in that sense, it's perhaps a wrong, or, at least, an endogenously paradox term, as the word citizen itself essentially means participation in public affairs.

In the same context, limited, but existing, are the emerging behaviours of informed health services consumers, an evolution of the concept of informed patient [...], another individual behaviour, and a concept related with market economy".

What would you call someone seeking advice from healthcare? A researcher? 

@ Eleni Koutsogeorgou

Totally agree. I like the (neutral) word user (in English, because, as you know, the word in Greek brings into mind drug addiction), but I have to present the evidence: health policy vocabulary (at least in some countries) shifts towards market-influenced/ market-promoted/ market-promoting terms (thus, the connection I make with neo-liberalism).

On the other hand, the questions raised in this project are mainly related with chronic patients, because, yes, diabetes mellitus and cancer are clinical conditions.

@ Christopher A Smith

I don't really get this question. Of course not a researcher, but, not everybody seeking advice from a healthcare practitioner (physician, nurse, whatever) is necessarily a patient.

Let's not forget the WHO definition of health:

"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO 1946;1948).

So, would you call a pregnant woman a patient? Would you call a teenage boy asking advice about condoms a patient? Would you call a fit man, with a normal body mass index, who asks advice from a dietician a patient?

References

World Health Organization (WHO) (1946;1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States and entered into force on 7 April 1948. Official Records of the World Health Organization, 2:100. 

The Definition has not been amended since 1948.

@ Michail Drakomathioulakis

In a word-YES. Why not? We all suffer from the human condition. (https://www.humancondition.com) Are we all not suffering from this condition right now? Is a medical doctor only a doctor when treating someone? And not a doctor when sick or injured? 

the WHO definition of health does not proclude the use of "patient" to describe any and all persons' sphere come into contact with the healthcare sphere. 

Perhaps business accumen has polluted the sphere of healthcare.

I write as an 84 year-old retired professor of medicine who has survived 54 years of clinical diabetes mellitus and 14 years with a transplanted kidney. I see regularly nine different "health care providers," MD, DO, DPM, PhD, all of whom I call "doctor" as they regard me as "a patient" whether my need is past, present, or future (actually, I'm on first name terms with all).

So, I suppose I'm a bit old fashioned, but my cognitively intact and very logical mind tells me:

If a person with a medical problem (pathology) should be called "a patient," why not apply that term to a healthy human seeking advice, a vaccine, or a history and physical examination before preparing for a marathon, all with the goal of avoiding pathology, "a patient" as well?

The former must be evaluated and treated for a particular, current pathological event while the latter seeks to preclude the risk of developing a condition that requires similar evaluation and treatment, i.e., pathology. If we do not refer to all people to whom pathology is a personal concern as patients rather than using different appellations based upon current need for one and future need for the other, we are losing to overly enthusiastic administrators who seek to justify their positions while complicating ours.

"Keep it simple, stupid."

@ Christopher A Smith

No, the WHO definition isn't exclusive of the term "patient", it just tells us that health is much more than just not being a patient.

I understand your point, but only if we take the word patient literally, based on etymology (the suffering one); thus, extending the context from healthcare to philosophy.

Because, the "human condition" is a rather philosophical context; policies, on the other hand, need to be practical. OK, one can argue that (some) political systems start as political philosophy ideas/ concepts, but, even them, when applied, need practical policies, otherwise don't survive (and with them, a lot of people die, too).

Moreover, if I think of the literal translation of the word patient into Greek (πάσχων/ páschon), my mind immediately leads to healthcare, or to theology. Well, yes, perhaps from a Christian or a Buddhist perspective we are all patients, but, then the context is too much out of the scope of this project, and, I could say of (applied) healthcare and health policy research.

@ Professor Franklin David Nash

Thank you for your answer. In your case (and sorry if I make it personal, but you brought the argument on the table), you have already some medical conditions, you (biologically) suffer from some pathologies. Thus, even a future need, is related to pathology (or, at least, should be considered together with the existing pathologies). It is a patient we're tallking about, indeed.

 Perhaps what we need here is a psychology point of view. Does an otherwise healthy person seeking for some health advice feels like a patient? How will that person feel if we start call her/ him a patient?

Moreover, I don't see why a boy seeking advice for condoms, or a girl asking about birth control pills "seeks to preclude the risk of developing a condition that requires similar evaluation and treatment, i.e. pathology".

Let's be honest, no matter how well educated a person is, in everyday life we don't use words as terms in a philosophical discourse (at least, that's what my everyday life evidence is, and that's what critical discourse analysis has taught me).

When we hear the word patient (or sick, or ill, or I don't know what other similar word in English), our mind goes to medical conditions. It doesn't go to philosophy, it doesn't go to theology, it doesn't go to etymology, it doesn't go to other contexts.

Simplicity doesn't mean simplification.

@Michail Drakomathioulakis

Question: If a primary care provider(PCP) has two groups of human beings that visit the office, one group has diagnosed abnormal physiology and the other group has no diagnosed pathophysiology but present themselves twice yearly for wellness maintenance and screening, Does the PCP not refer to all that walk through the door as patients? 

You mention political philosophy, de-humanizing people by re-categorizing populations have led to the extermination on millions of people. Taking the "patient" out of health care is akin to taking "Christ" out of Christmas. You are left with nothing more than financial transactions rather than Care and Love.   

Would the world be a better place if we thought of all of our neighbors as patients?

Again, we have strayed far from the intent of your original question but the discussion struck a cord. 

@ all participating in this thread. Thank you! I feel more energized about caring for my patients.

@ Michail Drakomathioulakis. I applaud your response to my post. Understand that I am but a simple biologist who now applies logic in my work with health and other  policies. My formal experiences in regard to philosophy are limited to a few undergraduate courses dealing primarily with philosophy of religion. In regard to etymology, I have great curiosity but no education or training.

I do regard the healthy pregnant woman as a patient, because by engaging in pre-natal care, she hopes to avoid complications or become aware of them early enough to make decisions that might save her and/or her fetus' life.

But that is my way, and I do not wish to impose it, particularly because I represent a generation that is approaching oblivion, very few of us indeed are actively involved in the health concerns of individuals although some may like me be active in health policy.

So, long ago, when I was dealing with individuals, healthy or ill, as I entered the clinic, I would ask, "How many patients today?" and I would be given a full and accurate count of the number of individuals I would be seeing.

I do not know how many participants in this discussion are medical doctors who have actively practiced. Perhaps the composition of this group has made the discussion more complex than necessary.

@ Christopher A Smith & Professor Franklin David Nash

I agree, in practice a healthcare professional may indeed refer to all people visiting his office, or she/he takes care of in a clinical and/or community setting, as patients. That's how I usually refer to them, too (my clinical experience includes CCU, ICU, and Cath Lab). From a (practicing) provider's perspective, that might be fine.

From a policy perspective, is that the right way? I agree, of course, healthcare must have "patients" on its focus; but, what that means for health promotion, health prevention, health education? How do we safeguard that it's "patient", and not "disease", on focus? How do we address personal needs, and safeguard individualised care? Again, from a policy, not from a practitioner's point of view.

@ Professor Franklin David Nash

Thanks for the applause, but I feel that I don't deserve it. My experience with philosophy, theology, and linguistics (etymology, including) is limited, too, and by no means regard myself as an expert in these fields.

Perhaps the composition of this group has made this discussion complex, indeed, but I think that's the point: to exchange ideas and points of view, and to enrich our experience.

In any case, thank you all for your answers, and Merry Christmas!

In my opinion it is certainly not. They are patients just as I am a patient when I seek medical care. However, we live in a world where the 'English' language is no longer sacrosanct.

@ Richard White. How right you are about "patients" of all types and about the English language. At my age (84), when writing or editing, my use of the language is concretely sealed in the days of yore.

I'm posting this for one reason, to make a point about an improper use that sends shivers through my being, figuratively and literally. When I come across a gerund that is not qualified by a possessive noun or pronoun, I cannot read further. I must sit, grind my teeth, and glower, wishing I had an editing instrument that can be used on my computer screen.

Now that I have gotten gerunds off my chest and mind, I thank you for your contribution.