Austin Lam is a medical student at the University of Toronto
We often hear and use the term “patient-centred care” without having a precise definition in mind. In order to elucidate the meaning of this term, it is important to analyze the concept lying at its centre: the patient. What does it mean to be a patient? What is the core, essential definition of patient?
Some have argued for patient to be replaced with a different term. As someone who has undergone surgeries myself, I have reflected on the meaning of this word and its associated implications. My hope is that this preliminary analysis can help provide directions for future questions, emphasizing an open exploration rather than closing off areas of discussion.
Let’s begin with the genesis of patient. Looking to etymology, we observe the following:
“suffering or sick person under medical treatment,” late 14c., from Old French pacient (n.), from the adjective, from Latin patientem (see patience).
This gives us two possible directions. First, the nature of suffering seems to play an integral role in what it means to be a patient. Second, we are pointed to the term patience. Following this trail, we see that the etymology of patience refers to the “quality of being willing to bear adversities, calm endurance of misfortune, suffering, etc.” Here, we are focused on the nature of how we might respond to suffering.
Generally, we do not intentionally choose to become patients. We involuntarily undergo experiences that are usually unpleasant from the medical illness at hand. The process of undergoing these experiences illuminates a more deep-seated aspect of being a patient: it forces us to ask, as philosopher Arthur Schopenhauer asked in his collection of essays titled Studies in Pessimism, “Why and for what purpose does all this torment and agony exist? … It is this: the will to live.” This is our shared human condition. When we become patients, we tap into our shared condition — where the term patient may become synonymous with “my fellow-sufferer, Socî malorum, compagnon de miseres.”
This leads naturally to the second consideration: how we might respond to suffering. So far, we considered how the suffering entailed by a medical illness is generally not one that we intentionally choose and is instead one that we undergo. In the vocabulary of philosopher Martin Heidegger, it may be said that we are thrown into a situation where we find ourselves with an illness (i.e., we find ourselves confronted by a concrete scenario). Notably, this is a scenario where we also find ourselves able to project ourselves into a different scenario (i.e., we have a range of possibilities for acting).
So, there exists a dynamic interplay between being thrown into a situation of illness and our projection into a different situation. Here, I do not use projection to mean someone can actively participate in their treatment plan (although this is an important aspect). Instead, I am referring to the state of mind we bring to each situation we are confronted with. We can — explicitly or implicitly — envision a range of possibilities to act upon when confronted by any given scenario.
To be thrown and to project are dynamic processes; we do not remain static in response to our illnesses. There is an element of transformation, of change, irrespective of whether we end up viewing it as “good” or “bad.” Thus, part of being a patient is to engage in a dynamic enterprise of self-change.
When I am confronted by a situation in which I find myself ill or sick, I am thrown into a suffering that taps into our shared human condition. Possibilities arise, including the recognition of fellow individuals as companions who share the human condition. Perhaps the most important implication of this is that for care to be centred on patients, we must remember “that which is after all the most necessary thing in life — the tolerance, patience, regard, and love of neighbor, of which everyone stands in need, and which, therefore, every [person] owes to [their] fellow” (Schopenhauer).
These are some of my preliminary reflections on the term patient. Much more remains to be explored to provide a more fulsome interpretation, and to postulate how this informs the meaning of “patient-centred care.”
Austin, your initial preliminary reflections are wonderful. Having practiced medicinine for 50 years and been and still am a “Patient”, I appreciated how you expressed my views and feelings well.
I remember my resistance to use the noun “Client” to replace “Patient” 20 years ago, for the definitions of “Patient” you described.
I look forward to your future blogs and wish you well on your journey into medicine.
Dr. Donald Prior, MD, FRCSC.