Council resolution on the use of the word "Patient"

From Division 35 Council Representative Debra Kawahara:

From: Council Representatives List [mailto:COR@LISTS.APA.ORG] On Behalf Of Rozensky,Ronald Howard
Sent: Wednesday, February 14, 2018 6:41 PM
To: COR@LISTS.APA.ORG
Subject: [COR] New Business Item for the March Council Meeting
Dear Council Friends and Colleagues:
Attached is the most recent draft of the new business item: Resolution for the Use of the term “Patient” In American Psychological Association Policies, Rules, and Public Relations Activities When referring to the Health-Related and Scientific Activities of Health Service Psychologists and Scientists in Health Care Services and Settings.
We began working on this item in the Fall of 2017 and used our Council listserv to request, and receive, two rounds of excellent feedback regarding clarifications of the intent and detailed wording of the item. We also forwarded the drafts to several caucus chairs, board chairs, and division presidents - and received feedback from all. Thank you all for your help. We have a strong list of co-sponsors and several divisions  executive boards have voted to support the item.
 
We have incorporated almost all of the feedback received and believe we have a motion that will help APA and our members incorporate contemporary language to help ensure we are seen as fully integrated members of the healthcare team.
We paid close attention to respect both the autonomy of our patients and the importance of their being an integral part of healthcare decision making and to our colleagues who work in a wide range of settings and have diverse connections to healthcare and other applied and scientific settings.
Our intent is to ask that this item be added to the agenda of the March meeting. We are hoping that there will be no objections to that request as we believe that this is an important, but straight forward issue, which should be addressed during this time of rapid changes to the health care system. We ask you to support adding this to the March Council agenda and look forward to your support during the discussion and vote.
Thank you,

Robert Resnick, PhD ABPP                           Ronald Rozensky, PhD ABPP
Division 42, Independent Practice               Division 38, Health Psychology
Past President, APA


Resolution for the Use of the term “Patient”
In American Psychological Association Policies, Rules, and Public Relations Activities
When referring to the Health-Related and Scientific Activities of
Health Service Psychologists and Scientists in Health Care Services and Settings

Whereas the Bylaws of the American Psychological Association (APA, 2017a) state that APA “shall advance psychology as a science and profession as a means of promoting health …” and it has been noted that psychology has “broadened its role … to that of a health profession” (VandenBos, Deleon, & Belar, 1991; Belar, 2014, p 3) with a long history of “increasing opportunity to collaborate with other health care disciplines in addressing important health issues” (Brown, et al, 2002, p 536); and

Whereas the breadth of psychologists’ roles, scope of practice, and activities as Health Service Psychologists (as defined within APA policy: American Psychological Association, 1996; American Psychological Association, 2011a; American Psychological Association, 2014) when working in interprofessional healthcare and when carrying out team-based science are expanding (Buscemi, Steglitz, & Spring, 2012; DeLeon, 2016); and

Whereas this expansion of psychology’s activities includes broader educational opportunities for, and training as Health Service Psychologists (Health Service Psychology Education Collaborative, 2013; Belar, 2014; APA, 2017b) while recognizing the importance of psychology’s role in broad interprofessional education and training and the development of shared, integrated, team-based health care competencies (American Psychological Association, 2017c) ; and

Whereas it has been noted that inconsistent use of terminology in the health care literature has “hindered the progression of knowledge about the essential elements of interprofessional collaboration … [and] that the single most important and tangible element of successful interprofessional collaboration is the importance of constant opportunity for frequent, shared informal communication” (Morgan, Pullon & McKinlay, 2015; p 1228) while some have suggested that interprofessional communication differences can lead to health care errors (Alvarez & Coiera, 2006); and

Whereas Health Service Psychologists who are involved in interprofessional health care have been encouraged by leaders in our field to develop competencies that include communicating clearly, concisely, and respectfully in a manner that is consistent with, and understandable to various healthcare audiences (other clinicians, patients, families, health care staff, and administrators) including the use of language appropriate to both those receiving psychological services and the professional cultures of other clinicians (Bluestein & Cubic, 2009; McDaniel, et al 2014); and

Whereas it is important to the discipline of psychology in general, and to each individual psychologist involved in health care, to be strong members of the interprofessional healthcare team (American Psychological Association, 2011b) and robust researchers in interdisciplinary team science (Rozensky, 2012); and

Whereas the term “patient” is the term predominately used in contemporary health care, across the entire domain of the interprofessional health care system including by most other health care professionals and scientists, and by third party payers, health care administrators, health care recipients and their families, Federal and State governments, and utilized in current APA policy describing practice in the health care system (American Psychological Association, 2011b) and may indeed be the preferred term by those receiving healthcare services (Deber, Kraetschmer, Urowitz, & Sharpe (2005); and

Whereas, it is important for each individual Health Service Psychologist who is involved in providing direct health care or in carrying out health-related research, to communicate effectively with other professionals by consistently using the contemporary language of healthcare (Cubic & Beacham, 2014; McDaniel, et al 2014):

Therefore, be it resolved that the American Psychological Association henceforth will preferentially use the term “patient” (rather than client)[1] in all of its publications, policies, rules, and public relations and news releases when describing those individuals (diagnosed with mental health, behavioral health, and/or a medical disease, disorder or problem) who are receiving health care services provided by those recognized as Health Service Psychologists. This includes all venues where health care services and/or health-related research endeavors take place.
Further, psychologists recognize that their use of the term patient within the context of a patient-centered health care system is encompassed within the broader umbrella of person-centered health care (WHO, 2018) which recognizes access to clear and concise health information, equitable access to health care, and supports the involvement of all individuals in their own health care decision making.
This policy recognizes the diversity of the populations and persons receiving psychological services and it further recognizes the diversity of our psychological community thereby noting that some psychologists working with some individuals in some areas of psychology such as, but not limited to, forensic, business, academic guidance, or school settings might use a term other than patient as recognized by current APA policy (American Psychological Association, 2011b). It is understood that psychologists will respect individual and/or cultural preferences expressed by recipients of psychological services and their families when choosing language to describe those individuals, families, or populations. Similarly, this policy does not restrict psychologists who are not identified as Health Service Psychologists, in any work setting, publication, or communication, from using the term patient where its use is appropriate in describing or discussing an individual or population of individuals who are receiving health care services or who are participants in health-related research.

Further, be it resolved, that it is vitally important that psychologists be perceived as co-equal members and stakeholders in the evolving health care system in order to ensure that psychological concepts and psychological science are incorporated in quality health care.

Thus, psychologists, and their students, trainees or supervisees in all educational and training programs, including graduate, internship, postdoctoral, and lifelong learning experiences, involved in preparing for and providing direct health care services, or carrying out health-related research, are encouraged to use the term patient[2], rather than client, when participating in their educational, scientific, or health service roles in the contemporary, interprofessional healthcare system.  This will help to ensure that their language is consistent with that of today’s health care system and health-related team science, and that all psychologists are perceived as being part of, and consistently integrated into, the culture of interprofessional, integrated healthcare today and the future.
References
Alvarez, G. & Coiera, E. (2006). Interdisciplinary communication: An uncharted source of medical error? Journal of Critical Care, 21, 236-242. doi.org/10.1016/j.jcrc.2006.02.004
American Psychological Association. (1996). Recognition of health service providers. Approved Council Resolution. C. (17). Retrieved from http://www.apa.org/about/policy/chapter-10.aspx#recognition-service
American Psychological Association. (2011a). Model act for state licensure of psychologists. American Psychologist, 66, 214-226. doi:10.1037/a0022655.
American Psychological Association. (2011b). Guidelines for psychological practice in health care delivery systems. Retrieved from http://www.apa.org/about/policy/hospital-privileges.pdf
American Psychological Association. (2014). Health Service Psychology: Preparing Competent Practitioners.  APA Council Policy Manual. Retrieved from http://www.apa.org/ed/resources/preparing-competent-practitioners.pdf
American Psychological Association (2017a). Bylaws of the American Psychological Association. Retrieved from http://www.apa.org/about/governance/bylaws/apa-bylaws.pdf
American Psychological Association (2017b). Standards of Accreditation for Health Service Psychology. Retrieved from https://www.apa.org/ed/accreditation/about/policies/standards-of-accreditation.pdf

American Psychological Association, Interprofessional Seminar on Integrated Primary Care Work Group (2017c). A Curriculum for an Interprofessional Seminar on Integrated Primary Care. Retrieved from: http://www.apa.org/education/grad/curriculum-seminar.aspx

Belar, C. D. (2014). Reflections on the Health Service Psychology Education Collaborative Blueprint. Training and Education in Professional Psychology, 8(1), 3-11. http://dx.doi.org/10.1037/tep0000027

Bluestein, D. & Cubic, B.A. (2009). Psychologists and primary care physicians: A training model for creating collaborative relationships. Journal of Clinical Psychology in Medical Settings, 16, 101–112.
Brown, R. T., Freeman, W. S., Brown, R. A., Belar, C., Hersch, L., Hornyak, L. M, Rickel, A., Rozensky, R., Sheridan, E, & Reed, G. (2002). The role of psychology in health care delivery. Professional Psychology: Research and Practice, 33, 536-545. http://dx.doi.org/10.1037/0735-7028.33.6.536
Buscemi, J., Steglitz, J., & Spring, B. (2012). The impact of team science collaborations in health care: A synopsis and comment on "Interprofessional collaboration: Effects of practice-based interventions on professional practice and healthcare outcomes". Translational Behavioral Medicine, 2, 378-379. DOI: 10.1007/s13142-012-0169-9
Cubic B., & Beacham A. (2014) Preparing the next generation for integrated care in medical settings: Training in primary care as a foundation. In Hunter C., Hunter C., & Kessler R. (eds.). Handbook of Clinical Psychology in Medical Settings. Springer, New York, NY doi:  10.1007/978-0-387-09817-33
Deber, R. B., Kraetschmer, N., Urowitz, S. and Sharpe, N. (2005), Patient, consumer, client, or customer: what do people want to be called?. Health Expectations, 8: 345–351. doi:10.1111/j.1369-7625.2005.00352.x
DeLeon, P. H., Sells, J. R., Cassidy, O., Waters, A. J., & Kasper, C. E. (2014, December 22).  Health policy: Timely and interdisciplinary. Training and Education in Professional Psychology, Advance online publication, doi:10/1037/tep0000077 . 

Health Service Psychology Education Collaborative. (2013). Professional psychology in health care services: A blueprint for education and training. American Psychologist, 68, 411-426. doi: 10.137/a0033265

Latdict (2018). Latin dictionary & grammar resource.  Retrieved from http://www.latin-dictionary.net/definition/10375/cliens-clientis

McDaniel, S.H., Grus, C.L., Cubic, B.A., Hunter, C.L., Kerney, L.K., Schuman, C.C.  ….  Johnson, S.B. (2014). Competencies for psychology practice in primary care. American Psychologist, 69, 409-429.  doi: 10.1037/a0036072

Morgan, S., Pullon, S. & McKinlay, E. (2015). Observation of interprofessional collaborative practice in primary care teams: An integrative literature review.  International Journal of Nursing Studies, 52, 1217-1230. Doi: 10.1016/j.ijnurstu.2015.03.008
Rozensky, R. H. (2012). Health care reform: preparing the psychology workforce. Journal of Clinical Psychology in Medical Settings, 19, 5–11. doi:10.1007/s10880-011-9287-7
VandenBos, G.R., DeLeon, P. H., & Belar, C. D. (1991). How many psychological practitioners are needed? It's too early to know! Professional Psychology: Research and Practice, 22, 441-448
Webster (2018). Retrieved from https://www.merriam-webster.com/dictionary.
World Health Organization (2018). People at the Center of Care. Retrieved from http://www.wpro.who.int/health_services/people_at_the_centre_of_care/definition/en/

Sponsors                     January 28, 2018
Robert Resnick, PhD     Division 42     Independent Practice
Ronald Rozensky, PhD Division 38     Society for Health Psychology
co sponsors
Armand Cerbone, PhD
Division 42
Independent Practice
Lisa Grossman
Division 42
Independent Practice
Anne Kazak, PhD
Division 54
Society for Pediatric Psychology
Daniel Marullo
Alabama Psychological Association
Nancy Molitor PhD
Division 42
Independent Practice
James Mulick, PhD
Division 25
Behavior Analysis
Peter Oppenhiemer
Division 31
State, Provincial & Territorial Psychological Association Affairs
Bruce Overmeyer
Division 3
Society for Experimental Psychology and Cognitive Science
Rick Seime
Div 38
Society for Health Psychology
Linda Sobell
Division 50
Society for Addiction  Psychology
Mark Sobell
Division 12
Society for Clinical Psychology
Brian Stagner
Texas Psychological Association
Gary VandenBos
Division 26
History of Psychology
Lenore Walker PhD
Division 42
Independent Practice
Danny Wedding
Division 12
Society for Clinical Psychology
Susan Whiteborn PhD
Division 20
Adult Development and Aging
Jeffery Younggren PhD
Division 42
Independent Practice
Barbara Ziegler
Wyoming Psychological Association

[1]           Professionals who routinely use the term patient: Physicians (MD), Osteopathic Physicians (DO), Podiatrist, Nurses, Dentists (DDS, DMD), Chiropractors, Occupational Therapists, Optometrists, Psychologists, Physical Therapists, Health Care Administrators.           
Professionals who routinely use the term clients: Lawyers, Accountants, Financial Advisors, Stock Brokers, Insurance agents, Hair stylists and barbers, Funeral Directors, Psychologists, Social Workers, Counselors, Architects, Advertising and public relations professionals, Photographers, Business Consultants.
Patient from the Latin patiens - suffering; Client from the Latin cliens – dependent of a patron (Latdict, 2018; Webster, 2018).                                                    

[2] Where appropriate, the term “participant” should be used when describing those patients involved in basic or applied health related research.

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