RESPONSE Response to Jackson, Hutchinson & Wilson (2016) Editorial: In defence of patients. Journal of Clinical Nursing Kath Peters and Colleen Cunningham We welcome the editorial by Jackson et al. (2016) that stimulates a much needed dialogue on the replacement of the term ‘patient’ with ‘client’, ‘consumer’, ‘customer’ and ‘service user’. We agree that these revised terms fall short of encapsulating the complex meaning of the word ‘patient’, which is understood by healthcare seekers and providers alike. Furthermore, the authors argue that chang- ing such language has implications in terms of how health- care seekers are framed and cared for. As Jackson et al. (2016) highlight, one of the reasons provided for the need to replace the word patient was to minimise power inequities inherent in dominant biomedical approaches. However, to promote patient autonomy and empowerment, we need to change the oppressive cultures and practices that may exist in some settings, rather than change terminology. In short, changing words does not change an oppressive system. In considering why healthcare professionals feel obliged to use terminology other than ‘patients’, the possible conse- quences this change in language evokes must be also be con- templated. We agree with Jackson et al. (2016) that the nurse/ patient dynamic is a relationship. Perhaps although changes in terminology may have been well meaning, the value-laden lan- guage seems to serve to breakdown nurse/patient relationships. That is, central to the therapeutic relationship is unconditional positive regard, and nurses are compelled to provide holistic care to patients to enhance their health outcomes. This does not sit well with the consumerism implied in terms such as ‘service user’, ‘client’ and ‘customer’. Neither does it fit with the reciprocal nature of the relationship between business pro- fessionals and consumers, whereby each party is driven by material gain. Therefore, we propose that substituting these terms may in part absolve the duty of care nurses have to their patients, where cost becomes a priority over individuals’ health needs and evidence-based practice. As McLaughlin (2009) points out, those providing healthcare become more accountable to their managers than to ‘service users’. The terms that have replaced ‘patient’ in contemporary healthcare are very much reflective of a business model, which can be seen in private health insurers’ marketing of their ‘pro- duct’, with the product being health ‘care’. Private health insur- ers promote healthcare as a saleable product in a competitive market. However, people do not have the choice of poor health and often do not have the capacity to shop around for the best deal. Furthermore, nurses practice compassion and provide care which is neither a commodity nor definitive; therefore, it is not apparent what ‘consumers’ are actually ‘using’. In fact, they are not ‘using’ or ‘taking’ but actually receiving. The term patient also infers vulnerability, which accu- rately reflects the position people are often in when seeking healthcare (Deber et al. 2005). Dismissing the idea that peo- ple may be vulnerable may inadvertently contribute to their oppression. By changing terminology, the onus is placed on the person seeking care and overlooks those who do not have reasonable access, or choose not to access services that may not meet their unique needs. This resonates with previous lit- erature which highlights that contemporary healthcare is framed in terms of financial consequences, and as a result individuals are considered responsible for their own health irrespective of accessibility to services (Rose 2007). Although arguments for replacing the term ‘patient’ lar- gely revolve around the negative connotations attached to the word, patients themselves have shown an overwhelming preference for the term patient over other alternatives (Deber et al. 2005). In addition, the words that have served as substitutes thus far can be construed as equally Authors: Kath Peters, PhD, RN, BN(Hons), Associate Professor, School of Nursing and Midwifery, Western Sydney University, Syd- ney, NSW, Australia; Colleen Cunningham RPN, Dip Ed, GDip (Mental Health), Practice Development Nurse, Thomas Embling Hospital, Melbourne, Vic., Australia Correspondence: Kath Peters, School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia. Telephone: +61 2 46203567. E-mail: k.peters@uws.edu.au © 2016 John Wiley & Sons Ltd Journal of Clinical Nursing, 25, e1–e3, doi: 10.1111/jocn.13403 e1