Patient: Difference between revisions

The word '''[[wikt:patient|patient]]''' originally meant 'one who suffers'. This English noun comes from the [[Latin]] word ''{{Lang|la|patiens}}'', the [[present participle]] of the [[deponent verb]], [[wikt:patior''{{Lang|la|patior]]}}'', meaning 'I am suffering,' and akin to the [[Ancient Greek|Greek]] verb {{Lang|el|πάσχειν (|italic=no}} (''{{Transliteration|el|paskhein}}'', to suffer) and its cognate noun [[wikt:{{Lang|el|πάθος|πάθος]]italic=no}} (= [[wikt:pathos{{Transliteration|el|pathos]]}}).

[[File:Receptionist attending to clients at the out patient.JPG|thumb|Receptionist in [[Kenya]] attending to an outpatient]]

An '''outpatient''' (or '''out-patient''') is a patient who attends an [[Outpatient clinic (hospital department)|outpatient clinic]] with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, their attendance is still registered, and the provider will usually give a note explaining the reason for the [[doctor's visit|visit]], [[medical test|test]]s, or [[medical procedure|procedure]]/[[surgery]], which should include the names and titles of the participating personnel, the patient's name and [[date of birth]], signature of [[informed consent]], estimated pre- and post-service time for a [[medical history|history]] and [[physical examination|exam]] (before and after), any [[anesthesia]], [[medication]]s or future [[therapy|treatment]] plans needed, and estimated time of [[Inpatient care#Progress|discharge]] absent any (further) [[complication (medicine)|complication]]s. Treatment provided in this fashion is called [[ambulatory care]]. Sometimes surgery is performed without the need for a formal hospital admission or an overnight stay, and this is called [[outpatient surgery]] or "[[day surgery]]", which has many benefits including lowered [[Health system#Financial resources|healthcare cost]], reducing the amount of [[medication]] prescribed, and using the physician's or surgeon's time more efficiently. Outpatient surgery is suited best for more healthy patients undergoing minor or intermediate procedures (limited [[urologic|urinary-tract]], [[ophthalmologic|eye]], or [[ear, nose and throat|ear, nose, and throat]] procedures and procedures involving superficial [[skin]] and the extremities). More procedures are being performed in a [[surgeon]]'s office, termed ''office-based surgery'', rather than in a hospital-based [[operating room]].

An '''inpatient''' (or '''in-patient'''), on the other hand, is "admitted" to stay in a hospital overnight or for an indeterminate time, usually, several days or weeks, though in some extreme cases, such as with [[coma]] or [[persistent vegetative state]], patients can stay in hospitals for years, sometimes until [[death]]. Treatment provided in this fashion is called [[inpatient care]]. The admission to the hospital involves the production of an [[admission note]]. The leaving of the hospital is officially termed ''discharge'', and involves a corresponding [[discharge note]], and sometimes an assessment process to consider ongoing needs. In the [[English NHS|English National Health Service]] this may take the form of "Discharge to Assess" - where the assessment takes place after the patient has gone home.<ref>{{cite news |title=Unpaid carers' rights are overlooked in hospital discharge |url=https://www.hsj.co.uk/workforce/unpaid-carers-rights-are-overlooked-in-hospital-discharge/7030840.article |access-date=16 October 2021 |publisher=Health Service Journal |date=8 September 2021}}</ref>

[[Misdiagnosis]] is the leading cause of [[medical error]] in outpatient facilities. When the U.S. [[National Academy of Medicine|Institute of Medicine]]’s's groundbreaking 1999 report, ''[[To Err Is Human (report)|To Err Is Human]]'', found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year,<ref>{{cite book |editor1-last=Kohn |editor1-first=Linda T. |editor2-last=Corrigan |editor2-first=Janet M. |editor3-last=Donaldson |editor3-first=Molla S. |title=To Err Is Human: Building a Safer Health System |date=2000 |publisher=National Academy Press |location=Washington D.C. |doi=10.17226/9728 |pmid=25077248 |isbn=0-309-06837-1 |url=https://www.nap.edu/read/9728/chapter/1 |language=en|author1=Institute of Medicine (US) Committee on Quality of Health Care in America |last2=Kohn |first2=L. T. |last3=Corrigan |first3=J. M. |last4=Donaldson |first4=M. S. }}</ref> early efforts focused on inpatient safety.<ref>{{cite journal |last1=Bates |first1=David W. |last2=Singh |first2=Hardeep |title=Two Decades Since: An Assessment Of Progress And Emerging Priorities In Patient Safety |journal=Health Affairs |date=November 2018 |volume=37 |issue=11 |pages=1736–1743 |doi=10.1377/hlthaff.2018.0738|pmid=30395508 |doi-access=free }}</ref> While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical errors are even more likely to happen in a [[doctor’sdoctor's office]] or outpatient clinic or center.{{Citation needed|date=November 2022}}

A '''day patient''' (or ('''day-patient''') is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by [[psychiatric hospital]] services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for [[day surgery]].

==Alternative [[terminology]]==

Because of concerns such as [[dignity]], [[human rights]] and [[political correctness]], the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include '''health consumer''', ''health care'healthcare consumer''', '''customer''' or '''client'''. However, such terminology may be offensive to those receiving [[Publicly funded health care|public health care]], as it implies a business relationship.

In [[veterinary medicine]], the '''client''' is the owner or guardian of the patient. These may be used by governmental agencies, [[Health insurance|insurance companies]], patient groups, or [[Health facility|health care facilities]]. Individuals who use or have used [[psychiatric]] services may alternatively refer to themselves as [[psychiatric survivors movement|consumers, users, or survivors]].

In [[nursing home]]s and [[assisted living]] facilities, the term '''resident''' is generally used in lieu of ''patient'',.<ref>{{cite book |author1=American Red Cross |author-link1=American Red Cross |title=Foundations for Caregiving |date=1993 |publisher=Mosby Lifeline |location=St. Louis |isbn=978-0801665158}}</ref> but it is common for staff members at such a facility to use the term ''patient'' in reference to residents. Similarly, those receiving [[home health care]] are called ''clients''.

The [[doctor-patient relationship|doctor–patient relationship]] has sometimes been characterized as silencing the voice of patients.<ref>{{cite journal |last1=Clark |first1=Jack A. |last2=Mishler |first2=Elliot G. |title=Attending to patients' stories: reframing the clinical task. |journal=Sociology of Health and Illness |date=September 1992 |volume=14 |issue=3 |pages=344–372 |doi=10.1111/1467-9566.ep11357498|doi-access=free }}</ref> It is now widely agreed that putting patients at the centre of healthcare<ref>{{cite journal |last1=Stewart |first1=M |title=Towards a Global Definition of Patient Centred Care |journal=BMJ |date=24 February 2001 |volume=322 |issue=7284 |pages=444–5 |doi=10.1136/bmj.322.7284.444 |pmid=11222407 |pmc=1119673}}</ref> by trying to provide a consistent, informative and respectful service to patients will improve both outcomes and patient satisfaction.<ref>{{cite journal |last1=Frampton |first1=Susan B. |last2=Guastello |first2=Sara |last3=Hoy |first3=Libby |last4=Naylor |first4=Mary |last5=Sheridan |first5=Sue |last6=Johnston-Fleece |first6=Michelle |title=Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care |journal=NAM Perspectives |date=31 January 2017 |volume=7 |issue=1 |doi=10.31478/201701f}}</ref>

When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible.<ref name="neglect">{{cite journal |last1=Reader |first1=TW |last2=Gillespie |first2=A |title=Patient Neglect in Healthcare Institutions: A Systematic Review and Conceptual Model. |journal=BMC Health Serv Res |date=30 April 2013 |volume=13 |pages=156 |doi=10.1186/1472-6963-13-156 |pmid=23631468 |pmc=3660245 |doi-access=free }}</ref> Incidents, such as the [[Stafford Hospital scandal]], [[Winterbourne View hospital abuse]]|Winterbourne View hospital abuse scandal]] and the [[Veterans Health Administration scandal of 2014|Veterans Health Administration controversy of 2014]] have shown the dangers of prioritizing cost control over the patient experience.<ref>{{cite journal |last1=Bloche |first1=MG |title=Scandal as a Sentinel Event--Recognizing Hidden Cost-Quality Trade-offs. |journal=N Engl J Med |date=17 March 2016 |volume=374 |issue=11 |pages=1001-31001–3 |doi=10.1056/NEJMp1502629 |pmid=26981930}}</ref> Investigations into these and other scandals have recommended that healthcare systems put patient experience at the center, and especially that patients themselves are heard loud and clear within health services.<ref>{{cite book |title=Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. |date=6 February 2013 |location= London|publisher=Stationery Office |isbn=9780102981476 |url= https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry |access-date=23 June 2020}}</ref>

One important way in which patients can be placed at the centre of healthcare is for health services to be more open about patient complaints.<ref>{{cite journal |last1=Berwick |first1=Donald M. |title=What ‘Patient'Patient-Centered’Centered' Should Mean: Confessions Of An Extremist |journal=Health Affairs |date=January 2009 |volume=28 |issue=Supplement 1 |pages=w555–w565 |doi=10.1377/hlthaff.28.4.w555|pmid=19454528 |doi-access=free }}</ref> Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn about and improve patient experience.<ref>{{cite journal |last1=Reader |first1=TW |last2=Gillespie |first2=A |last3=Roberts |first3=J |title=Patient Complaints in Healthcare Systems: A Systematic Review and Coding Taxonomy |journal=BMJ Qual Saf |date=August 2014 |volume=23 |issue=8 |pages=678–89 |doi=10.1136/bmjqs-2013-002437 |pmid=24876289 |pmc=4112446}}</ref>