An older friend of mine has worn-out knees. That's what his doctor says, and that is what he feels, every day, climbing the stairs to his bedroom. He looks forward to the moment when he can go to the hospital for a knee-replacement operation. It could well be that, thirty years down the line, I will face a comparable problem. Yet I doubt whether all parties involved will be so down to earth about it. By then, my first-line health care counsellor might venture that I am experiencing a joint-related mobility challenge. He will advise me to visit a prime health care resort, where valued customers such as me can receive the appropriate mobility adjustment procedure.

We live in an age of euphemisms and newspeak beyond George Orwell's imagination. Thus far, we have seen the irresistible advent of this phenomenon in politics and the business world at large. No longer do we go to war, or do we lay off people. Instead, we implement peace and downsize our operations. According to an article in The Lancet of 23 December 2000, there are signs that the medical profession is finally catching up with this general trend. Companies providing medical insurance, as well as hospitals and other so-called 'managed-care organisations,' have a tendency to discourage terms such as 'doctor' and 'patient,' preferring new labels like 'health care provider,' 'client' and 'customer'. The old words would maintain a power structure that we no longer find to our liking.

However, when people coming to hospitals and clinics are asked what they prefer, the overwhelming majority opts for the traditional terms of 'patient' and 'doctor.' Admittedly, among younger people and women in general a slightly higher percentage is in favour of terms other than 'patient'. This divergence shows what we already know: that change is something we like during youth and that, on the whole, women tend to treat people on a much more equal basis than the average man does. Whatever these statistical differences, people say that they simply don't like these new words. Polls of patients and reader reactions in The Lancet of April 2001 indicate an overall fear that this seemingly small change of terms is only a sign of things to come: the vanishing of the personal doctor-patient relationship, and the transformation of medicine into yet another impersonal commodity, subject to the rules and advertisement fads of the market place.

Is there nothing positive to say in support of the new terminology? Maybe there is. Most importantly, we might be comforted by the warm and fuzzy tone of these new labels. Being a client, a customer, or a health care user might have less-threatening overtones than being a patient. As some aspects of medical care can be rather intimidating, a euphemistic terminology could help to maintain a positive outlook. It is not likely that a wholesale adoption of these and other new terms would confuse doctors, patients, or third parties about the matters at hand. As the old bard himself, our beloved Shakespeare, once wrote: 'a rose by any other name would smell as sweet.' And this was in a time when straight talking was still valued.

If the new terms are indeed more in tune with modern ways and help to create a better relationship between patients and doctors, then so much the better. Yet it becomes a problem when new words stand in the way of the personal bond between doctor and patient; when they make people feel uncomfortable and when they signal the onset of a fundamental change in the medical profession. That apparently is the fear of many present-day health care consumers. A good reason for them to stay patients.