I first heard the term when I was a student. 'Client-centred therapy' was a fashionable US approach to psychotherapy and even then, when my bulldust receptors were still primitive, I found the word annoying.
'Client' was used sparingly in Australia in a medical context until the incipient managerialism of the 1980s allowed it to creep into more common use. From the outset, its adoption has been largely divided along professional lines: from surgeons and physicians — who never use it; to psychiatrists and nurses — who sometimes use it; to allied health practitioners — who favour it.
I was once, alas, fortunate enough to be invited to a 'workshop' to help write my hospital's mission statement. In this medical Tower of Babel, the doctors talked about their patients, the managers counted their clients and the community representatives defended themselves as consumers.
Promoters of the terms 'client' and 'consumer' want to change the way the sick person is considered by the health system. And how could this not be a good thing? The consumer movement, beginning in the 1970s, forced medical institutions and professions to take stock of the way they dealt with human beings.
But it came at a cost: if you call sick people 'clients' you risk turning healing into a commodity to be purchased (or rationed). Customers buy 'things' and so doctors compete to sell them: if you employ the words of the marketplace, you set the tone for the behaviour of the stallholders.
If medicine is constructed principally as a business activity, then the ethics of the healing hand that have driven the profession for millennia may be replaced by the workings of the invisible hand of Dr Smith.
The word 'patient' comes from the Latin patiens: 'one who suffers or endures'. If you have ever been one, then you get it. 'Client' on the other hand, is derived from cliens — a 'follower' or 'retainer' and was originally used in ancient Rome to describe the relationship between a plebeian and a noble.
I am intrigued that those seeking to change the perceived power balance between doctors and the people they treat, should abandon a term which describes the state of being sick, in favour of one that, from an etymological basis at least, actually highlights the inequality.
And what of the egregious term 'customer'? Although its origins are Middle English, a person of my vintage may recall the 1960s television program Pick a Box where Bob Dyer greeted us in his American accent with the words 'Howdy customers'.
Perhaps that's how we should welcome the sick at the doors of the emergency department: flashing lights and a word from our sponsor. Why not go the whole way and put up a sign saying 'the customer is always right'?
Well, for one thing, because they're not. The rule exists for shopkeepers so they can maintain their patronage. Placating a few grumpy and/or ignorant people each day is the price of good 'word of mouth'.
But a professional encounter is something different. If a patient believes the swelling in his groin is caused by the bubonic plague then he is almost certainly wrong. If he demands that you prescribe mega-doses of vitamin C for his HIV infection instead of antivirals then he needs better advice. If the voices from the microwave say Martians have landed then this is a call for help, not an opportunity for the sale of a laser gun.
The task of the salesperson is to find out what people want; the duty of the doctor is to find out what they need. And when you are sick you usually have no idea what you want, except to be better. To ensure that you do get better, the society has to guarantee the integrity of the training and the behaviour of the people who are looking after you. Some would call this a performance indicator — I call it a professional obligation.
Boosters see clients as autonomous agents who carefully choose the services they desire. They argue that if we call them patients, they will be suborned by a patriarchal profession and have less choice and autonomy. This is often true: that's the point. There is no time to google local cardiologists when you wake in fright with crushing chest pain; no scope for auditioning obstetricians when your waters break on the bus home ...
It is ironic that the person who is most often referred to as a client is the one who uses psychiatric services. Calling those who are depressed 'clients' will not make it easier for them to find a doctor equipped to treat their condition, nor will it improve government funding. Indeed, the language is an inhibitor of reform as it suggests there is a group out there ready to effect change and all we need to do is respond to the market forces.
The crisis in mental health services is a failure of our whole society — we have ignored the human rights of those who are least able, while they are sick, to be their own advocates. It is only when we recognise that the problem is an anticipatable responsibility of government and of the professions that we see action.
I recently heard a doctor talking on Radio National. 'I don't like the word patient,' he said. 'It creates a barrier between the doctor and the person who is suffering.' Etymological nit-picking aside, I believe he is simply wrong. The thousands of people I have seen in a professional capacity have always referred to themselves as 'patients'.
To be a patient is to place yourself, sometimes literally, in the hands of another person, to give them your trust and to expect it to be honoured. To become a patient is an intimate, self-revelatory and necessarily conscious act. What happens between a doctor and a customer sounds more like a financial transaction.
Frank Bowden is Professor of Medicine at the Australian National University Medical School in Canberra.