William,
I apologize about forgetting my name and will be more mindful of this
in the future when cutting and pasting from Word.

I had an interesting conversation today with an elder at a Unitarian
church I have been semi-involved with in the past. We spoke at length
about the fact that, since they didn't acknowledge any definite deity
or had an stable minister, they were often considered a "social group"
at best and a "cult" at worst. In other words, they were an
"alternative" spiritual option and therefore had difficulty recruiting
from the larger, mostly conservative community. One reason for this
was the lack of a recognized structure within which the new member
could feel comfortable making the transition into an often radically
different way of the thinking.

Likewise, as communal or egalitarian as I would like to be as an ND,
there are constraints on how far I can pushed that based on the
culture and community I find myself in. A portion of that is simply
hospitality, which is excellently discussed in the book Setting the
Table, by award-winning restaurateur Danny Meyer. But as I referenced
in my last email, there is the larger issue of therapeutic authority.
When you are absolutely certain that your patient does not need, and
will be harmed, by being drugged into oblivion for their grief, or
family of origin issue, or "ADHD", what is going to give you the
leverage to convince your patient to agree with you when their spouse,
parent, MD, therapist, social circle, or the media is against you?

As an ND, you are generally not given the therapeutic authority of an
MD and if you happen to be a petite, female clinician as is the case
with my wife, it is even harder. Therefore, I believe that one should
consider not only what you are comfortable with, in terms of
structuring your practice, but what is your client/patient comfortable
with, particularly when you are first starting out. Like the church I
mentioned above, we are often introducing the client/patient to
radically new ways of thinking about health. They require a structure
that both allows them to make that transition and allows them to be
comfortable trusting what their ND is telling them. In other words, to
be a doctor, there needs to be a way for therapeutic authority to flow
successfully. The main reason I always refer to my wife as "Doctor"
when I am in the clinic dealing with patients and never by her first
name is exactly to support this kind of flow.

You are, of course, free to do whatever you want in this regard. But I
would argue that referring to your patients as clients in your
promotional material or in your discussions opens up a possible point
of confusion. Realtors have clients, car salespeople have clients.
This does not given them the authority to make a diagnosis or put
someone on a detox protocol. Also, if your patients come to you
thinking of themselves as patients and they are looking for a doctor,
would not referring to them as clients give them pause? Might they not
wonder if the practitioner was not comfortable handling the
responsibility of being a doctor, since the practitioner is not
referring to them like other doctors or as they see themselves? Might
they not wonder if being a client means they will not receive medical
care but rather health advice or peripheral care that one might
receive from a nutritionist or a massage therapist?

Ultimately, this discussion is academic and probably not very useful
to you because it is a conversation you need to have with your
clients/patients/ people/whatever. I would encourage you to do this.
When we were deciding whether to buy a new clinic building across the
river from our current location, we were worried that we would lose a
significant number of our patients. The bridge is packed in rush hour
and generally the drive for some people would be 10-15 minutes longer.
Not being able to decide, we asked our patients (doh!) by giving them
the opportunity to fill out a survey. Overwhelmingly, they were
supportive of the move. We were amazed. It turns out that the parking
at our old location was terrible, something we were unaware of. The
take home message for me was that, in medicine as in life, sometimes
only the empirical option works. Sometimes, you just have to ask.

Gary Piscopo, ND, LAc

> Re: Patients vs Clients
> Posted by: "William Franklin" wfranklin_4@ yahoo.com wfranklin_4
> Sat Nov 24, 2007 4:30 pm (PST)
> A quick reminder, could everyone please remember to sign your post with
> your name?
>
> Thanks for this piece "swanoir". For the record, my issue isn't with being
> called a doctor or not, that will happen however it's supposed to. My
> original post was around, how I wanted to see the people coming in to see
> me. And, when I looked at the actual definition of the term "patient" and
> saw how clearly it defined what most people experience when they go to a
> doctor, I first wondered "which came first, the definition or the
> experience?" and second, do I really want people coming to me in that
> capacity. So, my preference is to use the term "clients" when I write about
> them in my brochures for example and speak of them as a collective group.
> It's been very interesting to see where this conversation has gone and to
> "hear" all the different perspectives. Mostly, it's great to have some
> dialogue on here again. Thanks Y'all!
>