- Email: [email protected]
Patient
Perspectives
Patient, when used in a medical context today, is a noticeably odd word since many of its uses convey a sense that is almost the opposite of the one that it originally signified. As a non-medical term, its continuity of meaning is striking. It first appeared in English as an adjective in the 14th century from the French and ultimately the Latin in which language it expressed the idea of enduring hardship. Patient has also long been associated with virtues such as being tolerant, obedient, and painstaking. But from its first appearance, patient also figured as a noun, meaning a person bearing difficulties without complaint. It was not much of a jump from there for the word to signify a person with an injury or disease and from there to mean one undergoing medical treatment. Geoffrey Chaucer in the Prologue to The Canterbury Tales uses the word in this way. In the 18th century, medical and non-medical meanings coexisted. But as doctors appropriated and narrowed the meaning of patient, the word’s reference to someone suffering in any other sense than the medical, from unrequited love, for example, disappeared. This eclipse was almost final by the end of the 19th century. The cause can probably be laid at the door of the hospital. Although hospitals have existed since antiquity, the idea that they were the best places to treat the sick poor only really took hold in the Enlightenment. After that hospitals became the accepted site for medical treatment. From the start, the bedridden inmates of hospitals were known as patients and hospital governors made rules regulating the behaviour of these people who were meant to acquiesce gratefully to their treatment. However, in the 18th century, patients, besides being sick individuals, began to be considered as populations and became a statistical category essential to the running of the modern state. By the 20th century, the taxonomy of patients had proliferated to include such terms as inpatients and outpatients. Nevertheless, patient still largely implied a grateful recipient of medical care. In recent years, as an adjective, the word has been combined to construct terms that signify the very opposite of obedience: patient-power, patient-centred. Yet, and here’s the irony, despite the connotations of deference, behaving patiently was perhaps one of the few resources the sick poor ever had to exercise some subtle control over the clinical encounter.
Christopher Lawrence Wellcome Trust Centre for the History of Medicine [email protected]
www.thelancet.com Vol 371 January 5, 2008
Lifeline Sister Frances Dominica was born in Scotland in 1942, and trained as a nurse at the Hospital for Sick Children, Great Ormond Street and at the Middlesex Hospital, London, UK. In 1966, she joined the Society of All Saints, an Anglican Religious Community. She is the Founder and Trustee of Helen House, the world’s first children’s hospice and latterly Douglas House, a “respice” for young adults aged 16–35 years. She is an Honorary Fellow of the UK’s Royal College of Paediatrics and Child Health.
Helen and Douglas House
Historical keyword Patient
What would be your advice to a newly qualified doctor? To listen. It’s not for nothing we’ve been given two ears and only one mouth. What’s the best piece of advice you have received and from whom? My mother advised me never to be early for anything— you can fit two or three other things in before you have to arrive. What apart from your family is the passion of your life? The greater wellbeing of children and young people with life-shortening conditions and their families. What are you currently reading? Made for Laughter by Dr Sheila Cassidy and Shattered Lives by children’s campaigner Camila Batmanghelidjh. What’s your worst habit? Some might say being late. What is the most memorable comment from your school reports? “If she concentrated she would do better.” Which would you choose, money or power? Neither—inappropriate for a nun. Although, actually, I can think of plenty of uses for both. You can have dinner tonight with a famous person of your choice (dead or alive), who would it be? Elizabeth Fry, Quaker and prison reformer and my hero since I was 8 years old. Which patient has had most effect on your work? Helen House sprang from my friendship with the parents of a seriously ill little girl called Helen who lived at home but required 24-hour care. Their experience highlighted the need for respite care and support for such families. Who is your most influential teacher and why? The poet U A Fanthorpe who taught me English at school and who believed in me when most didn’t. What is your favourite piece of music? Benjamin Britten’s War Requiem: it speaks for all time. What is the naughtiest thing you have ever done? Speeding frequently and yes, I do have points on my licence (my mother’s fault for advising me never to be early for anything).
For more on Helen House and Douglas House see http://www. helenanddouglas.org.uk
21
Patient, when used in a medical context today, is a noticeably odd word since many of its uses convey a sense that is almost the opposite of the one that it originally signified. As a non-medical term, its continuity of meaning is striking. It first appeared in English as an adjective in the 14th century from the French and ultimately the Latin in which language it expressed the idea of enduring hardship. Patient has also long been associated with virtues such as being tolerant, obedient, and painstaking. But from its first appearance, patient also figured as a noun, meaning a person bearing difficulties without complaint. It was not much of a jump from there for the word to signify a person with an injury or disease and from there to mean one undergoing medical treatment. Geoffrey Chaucer in the Prologue to The Canterbury Tales uses the word in this way. In the 18th century, medical and non-medical meanings coexisted. But as doctors appropriated and narrowed the meaning of patient, the word’s reference to someone suffering in any other sense than the medical, from unrequited love, for example, disappeared. This eclipse was almost final by the end of the 19th century. The cause can probably be laid at the door of the hospital. Although hospitals have existed since antiquity, the idea that they were the best places to treat the sick poor only really took hold in the Enlightenment. After that hospitals became the accepted site for medical treatment. From the start, the bedridden inmates of hospitals were known as patients and hospital governors made rules regulating the behaviour of these people who were meant to acquiesce gratefully to their treatment. However, in the 18th century, patients, besides being sick individuals, began to be considered as populations and became a statistical category essential to the running of the modern state. By the 20th century, the taxonomy of patients had proliferated to include such terms as inpatients and outpatients. Nevertheless, patient still largely implied a grateful recipient of medical care. In recent years, as an adjective, the word has been combined to construct terms that signify the very opposite of obedience: patient-power, patient-centred. Yet, and here’s the irony, despite the connotations of deference, behaving patiently was perhaps one of the few resources the sick poor ever had to exercise some subtle control over the clinical encounter.
Christopher Lawrence Wellcome Trust Centre for the History of Medicine [email protected]
www.thelancet.com Vol 371 January 5, 2008
Lifeline Sister Frances Dominica was born in Scotland in 1942, and trained as a nurse at the Hospital for Sick Children, Great Ormond Street and at the Middlesex Hospital, London, UK. In 1966, she joined the Society of All Saints, an Anglican Religious Community. She is the Founder and Trustee of Helen House, the world’s first children’s hospice and latterly Douglas House, a “respice” for young adults aged 16–35 years. She is an Honorary Fellow of the UK’s Royal College of Paediatrics and Child Health.
Helen and Douglas House
Historical keyword Patient
What would be your advice to a newly qualified doctor? To listen. It’s not for nothing we’ve been given two ears and only one mouth. What’s the best piece of advice you have received and from whom? My mother advised me never to be early for anything— you can fit two or three other things in before you have to arrive. What apart from your family is the passion of your life? The greater wellbeing of children and young people with life-shortening conditions and their families. What are you currently reading? Made for Laughter by Dr Sheila Cassidy and Shattered Lives by children’s campaigner Camila Batmanghelidjh. What’s your worst habit? Some might say being late. What is the most memorable comment from your school reports? “If she concentrated she would do better.” Which would you choose, money or power? Neither—inappropriate for a nun. Although, actually, I can think of plenty of uses for both. You can have dinner tonight with a famous person of your choice (dead or alive), who would it be? Elizabeth Fry, Quaker and prison reformer and my hero since I was 8 years old. Which patient has had most effect on your work? Helen House sprang from my friendship with the parents of a seriously ill little girl called Helen who lived at home but required 24-hour care. Their experience highlighted the need for respite care and support for such families. Who is your most influential teacher and why? The poet U A Fanthorpe who taught me English at school and who believed in me when most didn’t. What is your favourite piece of music? Benjamin Britten’s War Requiem: it speaks for all time. What is the naughtiest thing you have ever done? Speeding frequently and yes, I do have points on my licence (my mother’s fault for advising me never to be early for anything).
For more on Helen House and Douglas House see http://www. helenanddouglas.org.uk
21