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Wednesday, September 2, 2015

What is in a name?

I've been watching a debate on the HL7 Patient Care list about the name of a work product currently described as the "Patient Generated Document, Personal Care Goals, Preferences, and Priorities", which is a change from the original "Personal Emergency, Critical, and Advance Care Plan Document".

One part of the debate is the proper term to use where "Patient" is presently. As an engineer, I learned a long time ago that the names of things don't much matter from an implementation perspective.  As long as I know what you are talking about (in other words, we have a good definition of what it is), then I can implement it.  While the name could make it more obvious (and thus more usable), it isn't an essential attribute.

Most of the debates about what to call current or prospective users of healthcare goods and services resort to some name defined and specified from a position of authority, but with little evidence to back it up.  At best the evidence is based on consensus of an expert group which lacks representation from non-expert subjects who fit the definition of the category being define.  I find such debates to be:

  1. Largely useless.
  2. Tending towards annoying as the resulting list traffic usually just offers up more opinions based on other aforementioned authority figures (or based on personal understanding and authority).
  3. Vaguely amusing, as often some of the debaters are the same folk who wonder why people thing HL7 (or any other standard) is so difficult to understand.
If you really want to solve this problem, build up some evidence.  Do a study.  In this example, find out (click the link to weigh in) what current and prospective users of healthcare goods and services actually want to be called. There are scientific methods to approach that problem.  But please, stop wasting time arguing from a position of perceived authority, because frankly, the reality, when you dig into the evidence is much different from perception.

The name of the thing might be important to understanding, but what is more important (and has always been in any vocabulary discussion), is the meaning behind the name. Don't limit yourself to too few words (80 characters is often not enough) to describe a concept, but also don't make the definition so prescriptive that it can only be used in a single use case.

If it comes down to picking a name, rely on a published authority that the common man will understand.  If what you mean is not the same thing as you'd find in a dictionary, either find a name that better describes the concept, or give it a brand new name that won't be confused and overloaded. Forget your authority, rely on the evidence that can be provided by your target audience.  Failing that, avoid the desire to come up with the perfect name, and the endless debate that goes with it.  Because you cannot succeed.  Somebody won't like it.  I may not even like it, but as long as I understand WHAT you mean, I can live with it.

What is in a name?  A possibly shared understanding of the concept.  Don't rely on the possibility. Ensure it.  

I've built a little survey for you to tell us all what you think about the name, and why.  You can take it here.

P.S.  I find myself also amused by the fact that while I'm taking a course on Evidence Based Medicine, I'm also thinking about the uses of evidence in standards.

P.P.S.  Just to add my own two cents to the debate, I like Health Consumer or Healthcare Consumer as the name of the concept of current and/or prospective user of healthcare goods and services. Consumer doesn't quite cut it because its definition doesn't cover the context of health or healthcare, and patient doesn't quite cut it because its definition doesn't quite address the prospective aspect of the concept.  So there, I'm just as guilty as the next person.


  1. Very well-argued setdown over the discussion that precipitated this column. You mention Evidence-based medicine; what is lacking in a lot of evidence-based practice (EBP) protocols is practice-based evidence. And BTW, I appreciate that you tepidly endorse the concept of consumer as the end-user of health care and its related products and services.

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