Tag: technology

Language around healthcare provision has been changing over the last few decades, with a stronger emphasis on people’s role and capacity in making their decisions on the care options they wish to receive. This shift is motivated by the intent to balance the power dynamics between healthcare professionals and people who receive care, with the hope that this would reduce risk of harm/iatrogenic events.

Studies such as this examined people’s different preferences (in a mental health service context), and they all come with a reason – even for the less popular term “Survivor”, as the term appears to be describing their struggle to get relevant help in the system. The term “service user” is being increasingly used, within and beyond healthcare, in other domains such as social care or learning disabilities, where the people’s care needs is not necessarily seen as an illness. There is no good recommendation on which term should be used across all circumstances in people-facing materials.

Let’s take a step back: What the language is hoping to achieve, is to safeguard the relationship between healthcare professionals and people who receive care, such that individuals’ health is maximised. Language is relational. The study above highlighted the same thing: communicate and find out for whom which term is best used, and build this carer-cared relationship with respect.

My biggest qualm with the term “service user” is based on exactly this: how the term (potentially) changes the patient-doctor relationship into a consumer-provider relationship. I think the consumer-provider relationship comes with 2 major flawed assumptions:

assumption 1: All problems could be fixed, it is only a matter of price.
This thinking embeds deeply in capitalism that there is always a better solution to the current problem, over-estimating the capabilities of human knowledge on medicine.

assumption 2: All service providers are incapable – there is always someone else who can provide better services – reliance on competition. This is the other end of removing power from healthcare professionals. This removal of respect to professionalism changes people’s attitudes to help-seeking. People now ask for personal recommendations “Which doctor do you know is the best?” – instead of believing in the standards of which the profession is established on. The push to physician associates rides the same tide of the removal of professional standards of medical professionals.

Help-seeking is now dependent on social capital; better service is now linked with cost; the spirit of national healthcare service where health is a basic right is challenged – being healthy becomes a commodity. Inequalities, along with a thriving private healthcare service, will be widened as a result. The lack of a trusting relationship, and move to a transactional relationship between healthcare professionals and people also mean that the end goal of health service provision is no longer focused on individual functioning with alleviated illnesses, but patient satisfaction, which with the false assumption of what level of health is possibly attainable (in certain timeframe), could be impossible to satisfy. This fuels derogatory attitudes towards healthcare professionals, nurses, healthcare assistants, and doctors. No wonder retention rates of hospital staff remains low.

The same phenomenon and patterns are clear in other domains like education, and with the fast development in the capabilities of large language models and artificial intelligence, expertise is becoming less and less valued. Existing potentially trusting relationships between professionals and people need to be reforged and reimagined – and it all has to start with listening and involving people with lived experience in the generation of knowledge and expertise.

Culture changes, attitudes changes, patient may be a term running out-of-date, and service user may be no longer in favour. Healthcare provision has to capture, value and reward the building of trusting relationships, and have a longer-term vision in investing in community building. This is bigger than healthcare planning, but on the relationship between the people and their government and policy makers. The people are watching.