The language of health reform

By Joe Robertson, OHSU President

It’s a privilege to be a member of the Oregon Health Policy Board, the policy-making and oversight body for the Oregon Health Authority. The health policy board is a key voice in Oregon’s Health Care Transformation experience, and has given me the opportunity to share the perspective of an academic health center – particularly the vital role of a sufficient and well-distributed workforce to meet the growing demand.

Members of the Board share the same over-arching goals:

  • Access to quality, affordable health care for all Oregonians
  • Improved population health

However, it’s safe to say that our varied personal and professional backgrounds mean we all bring different perspectives to the table. Sometimes this is reflected in our reactions to the type of language used to describe reform, which I’ll admit occasionally has me reaching for my copy of the Oxford English Dictionary. I’d like to relay one such instance here.

At the last meeting of the Board, in July, we received a report and a presentation from the Medicaid Advisory Committee. The cover letter read as follows:

the committee strongly believes that person- and family-centered engagement in health and health care serves as the most direct route to achieving Oregon’s three-part aim for individuals served by the Oregon Health Plan. This conviction is reinforced by an increasing body of evidence that indicates individuals who are more engaged in their own health and health care experience better health outcomes, better experience of care, and incur lower medical costs.

The report then outlined the committee’s six-month effort to explore a range of strategies to support the stated goal of engagement.

There’s no question that the engagement of individuals in their own health and health care and that of their families is absolutely vital to achieving the Triple Aim. Nevertheless – in reading the materials in advance of the meeting – something about the language caught my attention.

The movement towards person- and family-centered care rather than patient-centered care is understandable and appropriate; we want individuals to take ownership of their own health and the term patient implies a certain amount of passivity. At the same time, I wanted to be sure that my colleagues on the Board understand that patient is not a pejorative term. For those of us trained as health care professionals, the relationship between provider and patient is a sacred bond.

So I turned to the dictionary.

Patient is listed as both an adjective (a descriptor for someone who practices patience) and a noun. One of the definitions for the noun is “a person receiving or (in later use) registered to receive medical treatment, esp. at a particular establishment or from a particular practitioner; a person staying in a hospital for medical treatment.” The first recorded instance of this usage was by Chaucer in The Canterbury Tales.

I read this definition to the Board during the meeting. I wanted to make clear for the record that I support the language of person- and family-centered engagement. But there are times when the term patient is still appropriate. There are times when an individual becomes compromised in their health, when he or she requires the care of highly-trained providers, and when those providers take responsibility for that individual. That responsibility, that bond, is implicitly what I hear when I hear the word patient. My colleagues appreciated this perspective, and it made me realize it’s one we should all be willing to share with friends outside of the health care community.

As we move through the era of reform, and as the language and structure of health care practice evolve, it is worth reminding those around us – as well as ourselves – that the bond between patient and provider is indeed sacred.