Not customers: doctors have patients, libraries have patrons, lawyers have clients and teachers have students

Originally published at:


politicians have victims


With a little grumbling and eye-rolling, my mom and her colleagues were able to make the adjustment from saying “cases” (or usually just “my families”) to saying “clients,” when management demanded it. Then came the order to switch to calling them “consumers.” She works for - I shit you not - Child Protective Services.


Not a bad point :grin:, but I would say politicians have constituents, and governments have citizens.


Might be relevant to note that up until the 70s the Legal and Architecture professions had fee schedules. For architecture at least, these were tied to the type and scale of a project. There was no cost competition, and the (highly idealistic, yes…) implication was that every practicioner was capable -hence their admittance into the professesion- and their expertise and labor worth a certain amount. Selection of one over the other was based on anything but undercutting price.

The US government sued to have these schedules dismantled as price-fixing, and now Architecture is often a lowest-bidder, hourly based affair. Undercutting price, with the inevitable focus on hours spent and profitability, has not increased the quality of buildings being designed and built here.


I cannot agree more with the comment about physicians. I would love it if we could be judged by outcomes, or by adherence to standards of care, but those are all very difficult to measure. So what the bean counters wind up doing is sending out “patient satisfaction surveys” which essentially ask if we told them what they wanted to hear and did what they wanted us to do. Needless to say, if you hold to science based medical standards, you are not going to be rated very highly by a lot of patients. Sadly, things like bonuses, pay raises and promotions are frequently based on these ratings, hence we find ourselves under pressure not just from our “Dr. Google” patients, but from administrators who want better patient satisfaction ratings. In the end, these folks neither know, understand nor care about little things like appropriateness of interventions, minimization of side effects, preservations of effectiveness for antibiotics, etc. They want us to massage the patients feelings, regardless of what that does to outcomes. Oh, and see the maximum number of patients in a given timeframe. I am usually able to explain my reasoning for pursuing a certain course of action, but that takes time. Just giving them whatever they ask for is quick, and move on. Yeah, we are doomed.


Several years back, we had a state librarian who wanted us to call library patrons ‘customers’, with the baggage implied by that change. A couple of state librarians later, we are given permission to call our patrons ‘patrons’ once again, but the damage has already been done. ‘Customer’ implies some type of paid exchange between library staff and the people who come in to use the library, whereas ‘patron’ is not so restrictive. ‘Customers’ feel empowered to abuse library staff if they don’t like the answer they get, as if we had mismade their breakfast sandwich, and treat the facility like their personal abode, down to being inconsiderate of others who wish to use it.


Generally unless we come to understand as a people that not everything can be valued and evaluated with money, we will come to an end sooner than later. Knowing this is easy… but the truth is we’ve already drunk, bathed in, and injected the poisoned water. Now what?


This reminds me of a speech touting single payer universal that a Canadian doctor friend of mine gives to his American counterparts. He usually concludes with something on the lines of “the Canadian system allows me to focus more on practising medicine and less on running a business.” The kind of doctor who would take issue with that concept is the kind of doctor you want to avoid.

As I’ve said before, “free” market fundamentalists want to see everything – including personal relationships – as a paid transaction, and the worst of them want that transaction to be as close to a zero-sum one as possible. After almost 40 years of having their way I’m glad to see pushback, especially from young people who understand how unsustainable this attitude is.


I prefer the British term “punter.”


Even worse is taking the design of the highest bidder and making the lowest bidder carry it out


People who insist on paying as little as possible for things where price may affect the outcome generally get what they pay for. Included in that fee ought to be forfeiture of the right to complain about unintended consequences.


I thought libraries had “visitors”? Maybe that’s a British thing.


I believe it is; at least that’s what I heard when I had a conversation with some of the staff at the Marylebone library branch. ‘Visitor’ is also a perfectly cromulent term, it implies the person is welcome (until proven otherwise), but not permitted to ‘make house’ in the stacks.


A similar trend that has bothered me for some time is the move calling people “citizens” to “tax payers”.

Beyond the fact that not all tax payers are citizens and not all citizens are tax payers, the name change implies that a citizen’s only duty is to pay taxes, ignoring voting, protesting, pressuring elected officials, and just doing your part to make things better.


Once upon a time, I attended a talk by Chris Matthews and his wife, then the anchor at the NBC affiliate in Washington DC, at Harvard. Both Matthews’ kept on talking about the “news consumer” and it rankled me. When I took my opportunity to ask a question, I told them I wasn’t a “news consumer” but a citizen and asked Matthews to outline a news network that would endeavor to inform the citizenry. He drew himself back and said he wouldn’t answer such a “goo-goo” [good government] question. He was affronted by my question and by my criticism, I think, of his and his wife’s view of their audience as “news consumers” rather than citizens.


It’s a little thing, but it still annoys me: our local (privatised) commuter train system directs all of its station announcements towards “customers” not “passengers” which, like everything mentioned previously, emphasises the wrong part of the relationship


This sounds remarkably British, I do hope people “tut” and write letters but never actually confront anyone directly as that wouldn’t be the right way to deal with this minor affront.


I remember one of our politicians speaking about the “business model” of Food Banks. Fucking Alphas has been ruining the world for millennia.

@Tamsin_Bailey I thought that British Libraries had “homeless”; especially in the periodicals section.


Oh? And how did he like being a news salesman or perhaps a news monger?