‘Patient’ Vs. ‘Client’: How Semantics Influences the Practice of Psychiatry

In a recent Psychiatric Times article posted on its website, Ronald W. Pies, MD, editor in chief emeritus of the publication, set off a lively discussion by calling into question whether the people psychiatrists care for should be termed their “patients” or “clients.”1 The debate that arose —with passionate arguments on both sides — revealed this is a concept that may be deeper than pure semantics.

Rather, it seems this may be emblematic of a larger question: Just where do psychiatrists fit in the mental health and medical professions, and what may that mean as the specialty moves into the future?

Psychiatrists straddle a unique position as both physicians and mental health therapists. Yet often, they are portrayed by one side as belonging too much of the other. I’m sure many of us have been told that psychiatrists are “not real doctors,” while, at the same time, our mental health professional colleagues might be heard to complain that we “are all about medications and not about the whole person.” So, if psychiatrists don’t really fit in as part of either discipline, which group’s terminology should we choose?

Interestingly enough, the term “client” originally evolved as a way for non-physician therapists to differentiate themselves from physicians, especially psychiatrists. The belief arose that physicians were beholden to a “medical model” where those they treated were looked upon as ill, and these people were thus beholden to a doctor “who held power” over them. By contrast, therapists stated they would collaboratively work with individuals they considered to be on the same level, and there was to be no “false dichotomy” between “sick” and “well.”

But of course, there are many medical situations where people don’t blink at being thought of as a patient, despite being completely healthy. Your child is your pediatrician’s patient when you go for a well-baby visit, you are your internist’s patient when you go for an annual checkup, and you are your dentist’s patient when you get your teeth cleaned. So the idea that calling an individual a ‘patient’ implies illness or powerlessness is really not prevalent in other specialties.