It should be noted that "professional", "patient", "consumer", "health service user" and "citizen" are not different categories of people, but describe different roles, which often overlap. It is normal for a person to have different roles at different times, or even at the same time, and role conflict is not uncommon among health professionals. An obvious example is the doctor or nurse who is or becomes a patient, or a parent with a chronically ill child who becomes a patient advocate. The term "user of health services" is a neutral catch-all term for all those who use or have used any health service, public or private, and is easily extended to include potential users too - that is everybody. However, some people do not use this term because it may carry overtones of drug use or misuse. Also, the term tends to denote client groups who are disadvantaged in some way (for instance wheelchair users) and who use social services rather than the health service. The word citizen also covers everybody, but encompasses all spheres of activity, not only health and illness, and hints at civic responsibility, as in citizens' jury.
Taken at face value, the term "consumer" means the same as "user", but its connotations differ. This is evident from the two meanings given in
Collins' English Dictionary (1982): "1. a person who purchases goods and services for his own needs; 2. A person or thing that consumes". The commercial overtones of the first meaning displease some people. The word also evokes consumerism, defined as "the protection of the interests of consumers". This gives it a slightly assertive, even militant edge, suggesting that consumers of health services are more likely to insist on their rights than mere patients or users. The word is therefore particularly apt in connection with research ethics committees, health authorities, funding bodies and the like, where consumer voices are increasingly given parity with those of the professionals. It does, however, have the same universality as user: we are all consumers -whoever and whatever else we may be. It is clear that there is no perfect label for the many potential roles that patients and their carers may take in health that is free of certain connotations, but for simplicity, we will use the term "consumer".
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