Archive for April, 2011

Consumer, Client, Patient, Analysand: What’s in a Name?

Thursday, April 28th, 2011

Willy Shakes asked the question in Queen Lizzie’s time (the first one, not the current monarch.) At that time he was asking because, to the questioner, a name was something that made no difference in the person to whom it was attached but made lots of difference as to how the person was perceived and accepted by others.

Insurance companies have renamed everyone who is receiving health care services. No longer are we “patients,” “clients”or, in the case of psychoanalysis and or psychotherapy “analysands.” We’re now “consumers,” according to the insurance companies. Those of us who are delivering health care services are no longer “doctors,” “analysts,” or “psychotherapists.” We’re all lumped under the title”provider,” again by the insurance companies. What does this mean? Don’t we still get treated the same as we did when we were patients and therapists, Analysts and analysands, etc?

Well, no. Not really and, on top of that, I don’t like being called a consumer when I’m on the receiving end of health care, nor do I much care for being called a provider when I’m on the giving end. Why? I’m gonna tell ya (with a nod to Dino. RIP.)

A consumer is someone who uses/purchases a good or service, which is considered a consumable. Very general. Doesn’t separate someone who is in treatment from someone who’d buying a toaster. Are you using my service? Yes. Does that make you a consumer? No. Our relationship is more personal than that, or, at least, is intended to be more personal than the relationship between someone buying a toaster and the salesman at an appliance store.

“OK. So I’m not a consumer,” you say. “Then I’m your client, right?” I’m not so sure. The dictionary on my e-reader says that a client is “a person…using the services of a lawyer or other professional person or company” (New Oxford American Dictionary.) I guess that sounds closer to the mark. I am a professional. Are you “using” my services? Well, yes and no. You have engaged me in my professional capacity. Maybe client does work but it seems to me that it misses something. It’s like chicken soup without the parsnip and dill weed. It’s may be good but it’s missing that geschmeck that makes it delicious.

What’s missing? You got it? No? Sure you do. The helping relationship. The (hopefully) healing relationship. So what’s the word now? Patient, right? Same dictionary gives the first use of the word patient as a noun to be “…a person receiving or registered to receive medical treatment.” Woah! Shazaam!, as Gomer was wont to say.) Shazoom!, as Captain Marbles said. “That’s it,” I hear you say. Well, yea and nay. Far better than consumer,  more better than client but still….

Analysand? What the hell is that? A person undergoing the process of psychoanalysis with a trained psychoanalyst. A very specific word that honors the relationship that exists in the room between us.

As for “provider….” Dad (in the stories of how family life used to be) is the “provider.” “Your father’s a good provider.” Can we talk about transference and countertransference here? I thought so.

So, what do you prefer to be called? What do the implications of “consumer” and “provider” mean to you? Add a comment and let us know. Keep those ol’ cards & letters rollin’ in (Dino, we miss you. Lots.)


“Yeah, but what’s my diagnosis?”

Tuesday, April 12th, 2011

Patients invariably want to know what diagnosis I’ve given them or the papers from somewhere else say they’ve been given. Some don’t ask. Many do. To those who do I’m really, really tempted to say, “What’s it to ya?” but I’d just be dismissed as being flip or, even worse, that I’m with holding some secret that will help do something, though I’m not sure what. Most of the time patients don’t know what that information is going to help either. I do tell patients that I’ll tell them but first I’d like to know what having that information is going to do for them. Most of the time the answer is something vague, like, “I just want to know what you’re writing about me,” or “I want to know what I’ve got.”

I know, you’re looking for an answer. You want to be told you’ve got Bi-Polar Disorder or Schizophrenia, or something, anything, as long as it has a name. Giving your condition a name explains what you have and then explains a course of treatment, right? That’s how it works when you go to the doctor. He says you’ve got Bronchitis, you take this prescription for antibiotic to the pharmacy, take a pill x number of times a day for y number of days and “you should feel better. If not, call me. Be sure to take all the pills.” OK, the doctor doesn’t say most of that, it’s written on the bottle the pills come in but it’s doctor (some doctor) who tells the druggist to put those labels on the bottle.

OK – you don’t really want to know you’ve been diagnosed with Schizophrenia or Bi-Polar Disorder because those are serious problems. So how about some depression or anxiety? Better? OK. Still, what does that tell you? There are clinical interpretations of those two words but I don’t really think that’s what you’re looking for because: there’s no antibiotic that you take for y number of days and it goes away. Medication can bring some relief, or so the pharmaceutical companies claim (more on that another time – I’m not anti-medication, just anti-miracle drug,) psychotherapy/psychoanalysis can bring some relief, the combination of psychotherapy/psychoanalysis and medication can bring more relief but, if you want real relief from what’s troublin’ ya (“What’s the matter bunkie? You say your brother hid your homework in the washing machine and now you algebra stuff is all over your underwear and the teacher is asking you to hand it in….”) you’ve got to change the things that are causing the condition, because that’s what your condition is a reaction to and a defense against.

We diagnose across five Axes (that’s acksees, not the things that have strings and make music), I-Clinical Disorders; Other Disorders That May Be a Focus of Clinical Attention II. Personality Disorders; Mental Retardation III – General Medical Conditions IV – Psychosocial and Environmental Problems and V – Global Assessment of Functioning.

When you ask me what is your diagnosis you’re usually asking me for the top item on the list. I hesitate to tell you because it doesn’t tell you anything about what’s going on. It barely tells me what’s going on. What it tells me is that your symptoms, your reactions to your General Medical Condition added to your Psychosocial and Environmental Problems, have been given this or that name and number by the taxonomists who need to track these things for statistical and other informational purposes, like whether you can have coverage under the new parity law or not (another post another time.) Same thing about Axis II except that’s more pervasive, more of a character style, than just a bunch of symptoms.

What you’d be asking if you knew what to ask is what do I see as the things that are pushing and pulling on you that are causing you to be this way. You’d be asking me ” How do I increase my GAF (Global Assessment of Functioning) so I can _____ (insert desired result here.)

Doesn’t matter. I’m still going to hear “What’s my diagnosis” or its variant “I took a test (looked it up, whatever) online. I’ve got this. Do you agree?”

I don’t know.  Please tell me more about it.