August 3, 2012

The Various Terms for Types of Patients

I have blogged about patients before, but I had not really researched the types of patients on the Internet. I approached my analysis from what I read on mostly diabetes sites and a few other web sites. Now it is time to discuss how some in the medical profession view patients and from some other sources. Even our doctors have different classes for us as patients. Most are very understandable and fit many patients. Most do not list us as compliant or noncompliant, although some may wish they could just label us that way.

The list I have been familiar with and that I use starts with patient, passive patient, proactive patient, empowered patient, and e-patient. I have also listed patient advocate to the list. I have listed the first three in this blog and the second three in this blog.

A doctor lists the following type of patients - passive-dependent, independent-skeptical, intellectual-researcher, expedient-flexible, and open-minded-exploring. I like that this list is a little more descriptive. Rather than duplicate his work, read his descriptions here.  This is spread out over five short pages.

The next list is different. I can understand the expansive list, but it seems a little too expanded. The list includes pleasant, courageous, angry, manipulative, demanding, drug-seeking, direct, all-knowing, noncompliant, anxious, psychosomatic, depressed, suffering patients, chronic pain, dying patients, and geriatric patients. The last type is one that needs to be listed and often is not on any list. For the author's explanations, read about the list here.

There are many other classifications for patients and this depends on the field of medicine and on the location of the patient. Fact is, I wonder if some of the patient types are designed to confuse people. Dentist have their list of patient types. Hospitals have several lists of patients types they use and some are even coded to prevent others from having an idea for the reason they are in the hospital. I am only listing one link although there are many such lists depending on the type of hospital and the patients each serves.

Neurology has a list of patient types. This is the last list I will link to as it raises many valid concerns when dealing with people that have no control of the condition they often find themselves. Nursing homes have a set of terms they use for their clients or residents. It seems many of the medical professions have their preferred list for patient types.

Psychologists and the related professions have a separate list of terms for their office patients, and those admitted to hospitals, and patients in mental facilities. There seems to be separate patient lists for records and another list of types for insurance purposes. I am still researching, but as of yet I can find no linking evidence.

In doing my reading, there seems to be different types of patients for everything and there is little crossover of patient types. Only once did I see both compliant and noncompliant listed on the same list. Three times I saw noncompliant in a list of patients. It is discouraging that patients are viewed so differently across the medical professions. I honestly feel this is to confuse us as patients and doctors in each specialty have their own code to describe us. After reading over 40 sources of patient lists, I admit I don't have a grasp on the reasons for so many different lists of patient types.

Could these lists be standardized? This is highly doubtful as I can see the need for some of the patient types in very specialized medical fields. As patients, we could generalize patient types, but it would never be accepted. We can only agree that there is a need for many patients types.

The one discussion I had with two doctors (a husband and wife practice) probably had the greatest impact on me and at the same time was the most rewarding. I ask the question of did they use the term noncompliant to describe patients. Both answered almost no immediately and stated the term was an insult to the doctor and to the patient. Each went on to explain that if the doctor did not take the time to explain a course of treatment and the reasons for the particular treatment and the patient did not understand the importance, then the doctor would be at fault if the patient did not find it important to follow the advice.

Both doctors felt that much of what others label a patient as noncompliant is the fault of the doctor. Both expressed the belief that there are some patients who will start out willingly, but dislike the routine and stop taking a medication or look to alternative medicine for answers. This is why they have developed a standard set of questions to ask any patient to assess whether the patient understands the reason for the treatment, if the patient agrees with the plan, and if there is a high indication the patient will not follow the treatment plan, or will seek alternative medicine advice.

One doctor said they had such a patient and termed this patient as an alternative medicine patient. When the doctor pressed the patient about why he even came to them, the patient answered that a correct diagnosis was being sought and if alternative medicine had a treatment, that would be the treatment of choice. If alternative medicine did not have a treatment, he would follow their treatment. Further discussion uncovered that the patient owned his alternative medicine/health food store and was very knowledgeable. The patient said that both doctors had never used the word noncompliant with him and that was the reason he would continue to have them as his doctors.

They admitted that this was an unusual doctor-patient relationship, but that they would make the diagnosis, discuss the treatment and the reasons, and the patient would go on his way. If the patient determined that the alternative treatment would not work, he would come back for the prescription and ask any questions needed. Only once has he come back for the prescription and a renewal in the two years of being a patient.

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