Agreed that it is an excellent article.

In response to your feedback, John, to the terminology used:
The phrase "more of them" was taken from the sentence "... It seems to me that DIABETICS are living longer while sicker, and this is why MORE OF THEM are surviving long enough to undergo end-stage operations like lower limb amputations..."

You mentioned:
"...may have been more inclusive to say 'more patients' or 'more people' are surviving longer, rather than 'more of them'. The othering nature of the term 'them' gives the impression that those in question are not a part of regular society...."

In my opinion:
In the context of the full sentence [strict construction] and the article as a whole [liberal construction], the use of "more of them" is appropriate, since the preceding part of the sentence clearly indicates that it was in reference to "diabetics".

In fact, my perspective is that using terms like "patients" does nothing in making a person more inclusive in society. If one looks at the origin of the term, it is probably one of the earliest forms of “othering” practiced in society.

The etymology of the term "patient" means "suffering or sick person" and is believed to come from the Latin verb "patior". It is based on a biomedical model of health; and from a sociological perspective, tend to disempower the individual labeled with the term.

The term “patient” also singles out and separates these individuals who are dissimilar [sick] and differentiates them from the main population [healthy]. The removal of autonomy excludes the differentiated individuals from society. In clinical research, terms like “participants” over “patient” are often preferred for this reason.

I feel the term “more people” is also not useful as it lacks the clarity and specificity that the point of interest is “individuals with diabetes who go on to develop gangrene and require end-stage operations like lower limb amputations..." rather than the “general population without diabetes who go on to develop gangrene who go on to require end-stage operations like lower limb amputations...".

I support your view that choice of language in an academic discourse is important. I also support the author’s stance that well-intentioned clinicians often stereotype amputees by the language they use in the public domain.

But before we (myself included) offer options of terms to be used, those substitute terms need first to be factually accurate, historically consistent, politically correct, culturally sensitive, scientifically specific, and contextually relevant. Such substitute terms used to convey accurate, consistent, sensitive, specific and relevant scientific information in the lay context must also be both prudent and efficient/economic. Having legally nuanced, politically correct, long descriptions to describe a simple concept is unlikely to be the best solution? Neither are alternate terms that do nothing in removing the original biases it sought to preclude?

Hi Michael,

Thank you for your further comment.

As a general rule, I think writers/commentators should be cognizant that in an academic discussion, prejudicial statements targeted at any group should be carefully phrased. Language and terms used should be objective and evidence-based, and if perspectives are anecdotal, be diligent in ensuring that it is not a prejudicial comment shrouded in “objective” personal opinion. In dealing with semantics and labels, it is also important that we first explore the etymology of words as a starting point for disentangling potential language conundrums.

The caveat is that we should perhaps also recognise and learn from related laws in harassment and discrimination that adopts a view that intent [term/word used] is irrelevant, as it is the outcome of the action [or interpretation of the word] – that is, the way the victim/reader perceives the behavior/word – that defines whether harassment [or language prejudice] took place.

I agree on the point of inclusiveness and the subtle (and not-so-subtle) ways that language can be used to exclude; even unintentionally.

In the context of this discussion, I am therefore not supportive of the term “client” nor “disability”. I will explain below my perspective on the two terms and provide reasons in support of that perception/stance.

When exploring the word “patient” versus “client” in the context of clinical practice, while I am not fond of the word “patient”, I am even less enamored with the term “client”.

“Client” is a term many members within the healthcare chain may refer to individuals that seek their help in a health context. In order to differentiate the the term “patient” over “client”, and why I preference one over another, it is important to look at the related term of “doctor” when discussing the context of clinical practice. This is because the word “patient” evokes within the general public the complementary word “doctor.”

The word doctor is said to be derived from the Latin “docere”, and meant “to teach”, and was originally applied to great scholars, but since middle ages has been used to refer mainly to the doctors in medicine. While there are individuals with a doctorate degree in nursing, in social work, and in psychology, the word “doctor” is still generally associated by the general public as someone with a medical degree.

In contrast, the word “client” comes from the Latin “cluere”, or, “to listen, follow, or obey”. Hence, a client is always listening out for another's orders, unable to take independent action. Client denotes a person of lowly status at another's beck and call and dependent on him/her.

In ancient Rome clients were plebeians who were bound in a subservient relationship with their patrician patron. Clients acknowledged their dependence on the patron and received his protection in return. Freed slaves automatically became the clients of their former owners.

The patron might represent and support the client in court (from which is derived the modern use, dating to the 17th century, of calling the customers of lawyers clients); in return, the clients provided services and even money to the patron.

Clients were expected to show deference to their patron, especially by calling on him every morning (salutatio). Clients became mockingly known as salutatores. In later periods, client came to denote a beggar and hanger-on.

In the healthcare context, using the term “client” also places the person seeking a service into a role of a “consumer”. That role and that description, when applied to the field of health, carries with it the assumption that there is an implicitly dangerous, exploitative relationship between a naïve consumer, who needs protection by a benign advocate against a conniving exploiter. The term also has a legalistic or business focus. This contradicts the very idea of a traditional doctor-patient relationship.

As previously discussed, the word “patient”, actually means “A sick or suffering person who undergoes medical care or treatment....” and is derived from the Latin “patior”, to suffer: The patient is he or she who suffers. I would posit that suffering is not a necessary and essential ingredient for a consumer. A consumer-provider relationship is not a therapeutic one, and a therapeutic relationship is sine qua non in a doctor-patient relationship.

By accepting uncritically the term “client” over “patient”, one could argue that we are placing the doctor-patient relationship further within the realm of a market-driven economy guided by the business ethos of the insurance/managed care and the pharmaceutical industries and overriding the duty-of-care guiding principles of the medical profession.

While a market-type model of health care is adopted in the US, many countries in the rest of the world (including Australia) still offer free (or heavily subsidized) medical care for all its citizens. In such model of health care, no individual is deprived of necessary medical care simply because he/she cannot afford it. There is an emphasis in such context a “fiduciary duty” towards the patient over simply what services the health care provider is being paid for. There is both an implicit and explicit expectation of patients, doctors, the public, and the courts that doing the right thing (i.e. the appropriate medical management) overrides any potential financial losses.

As alluded to in your reply post, the question of semantics may be of more interest to professionals than service users themselves. Even from that perspective, the research literature has shown that service users may still prefer to be addressed by the term “patient” or by their names in any interaction with their medical doctors.

With reference to the term “disability”, I feel that the use of the term “disabled people” and "disability" in the health care context is archaic and should preferably no longer be in common use. Health care providers should refer to their patients by name and define the issue to be managed by the defined disability; rather than defining the person by that disability.

The issue of using the term “disability” is based on a physical reference of an anatomical “norm”.

The prefix of “dis” is based on the concept of
- "lack of; not" (e.g. dishonest: "shame, want of honor"; disinherit: dis- "not" + inherit.);
- "do the opposite of" (e.g. disintegrate: dis- "do the opposite of" + integrate); or
- "apart; away" (e.g. discard: "to throw a card away," from dis- "away" + card, originally used in card-playing; dishevel: "to disarrange the hair," from des- "apart" + chevel "hair").

Hence "disability" means a lack of/not/opposite of/apart from "ability".

Based on our modern understanding of health, physical disability should be conceptualized as a functional issue rather than an anatomical one. That is why I personally prefer the term “pre-ability” rather than “dis-ability” in clinical practice and in an academic discourse. This indicates the capacity (or hope) to improve in functionality and has a positive/ rehabilitative connotation. I am unsure if anyone else uses this same term.