Observer Forum

‘Patients’ and ‘Clients’

In the wake of Roddy Roediger’s interesting discussion of the usage of “subjects” vs. “participants” in research reports, Christine Senn raised the question of referring to patients or “clients” [“Have ‘Patients,'” October 2004 Observer]. Because no one else has weighed in on this matter, I thought I might give it a try.

In research reports, the term patients can be justified as referring to those subjects who participate in experiments by virtue of the fact that they carry some medical (including psychiatric) diagnosis (such as schizophrenia or Alzheimer’s disease), and whose performance is typically compared to a control group of ostensibly “normal” subjects who are not carrying a diagnosis. The Oxford English Dictionary tells us that this use of the word to refer to those who are receiving medical treatment goes back to Chaucer, and it seems perfectly appropriate to preserve it. However, some practitioners think that the term “patient” implies an unacceptable level of passivity, and have proposed the term “client” instead — a usage that the OED traces to the social work literature of the 1950s. Given the primary meaning of the word “client,” referring to one who is dependent on the protection or patronage of another, it’s not clear that this is a good alternative.

In pragmatic terms of social role, though, it might be said that patients do what their doctors prescribe in order to get well; but lawyers and architects are paid to follow the instructions of their clients. So, in clinical or counseling situations, the choice between “patients” and “clients” might boil down to who is in the better position to know what the problem is, and how it should be treated — the person providing the service, or the one receiving it.

—John Kihlstrom
University of California, Berkeley

Footnotes and Rejections

As something of a veteran of footnotes and rejection letters, I have two personal items to offer as confirmations of some of the theses offered by Roddy Roediger [“The Greatest Literature Never Published,” June 2005 Observer].

The first item is what I believe to be the longest footnote ever published by the Journal of Experimental Psychology in a 1971 short-report paper (91, 161-4) by Karl Schiffman and me entitled “Test of the propriety of the traditional discriminative control procedure in Pavlovian electrodermal and plethysmographic conditioning” (I guess the title is pretty long too). The footnote dealt with methodological caveats expressed by an anonymous reviewer and by a colleague, Leyla De Toledo, at Toronto. The footnote is over 50 lines long, and, as I recall, we succeeded in persuading the editor, the late David Grant, to allow it in by submitting the first half first, and then the second part later.

Of the numerous rejection letters that I have received, the one I treasure most is that from the editor of the Canadian Psychologist to which John Mueller (a fellow Canadian) and I first sent our paper “Research Ethics Boards: A Waste of Time.” The work was later published in the Observer as a two-piece article: www.psychologicalscience.org/observer/0901/irb_reviewing.html and www.psychologicalscience.org/observer/1001/irbsystem.html. The Canadian evaluation of this work was, essentially, that it was itself a waste of time: www.psych.utoronto.ca/~furedy/Papers/be/tricREBs%20review.doc.

Certainly John and I think that the Web is a better way of storing this information for future students of psychology than in some musty filing cabinet or container.

—John Furedy
University of Toronto

Make-up ‘Tips’

I tend to read articles by Baron Perlman and Lee McCann with interest and enthusiasm, but their recent advice about the design of make-up exams raised some questions for me [“Teaching Tips,” June 2005 Observer].

The authors stated that make-up exams “should not be more difficult than the original test but must be, as best as you can design, alternative forms of the same exam.” First, instructor views about the appropriate levels of difficulty for make-up exams are likely to be highly variable and, in the absence of empirical evidence regarding the long-term impact on students’ careers, it seems more a matter of instructor opinion. I doubt if there is a single demonstrably correct approach to this matter. In fact, a good argument can be made that make-up exams should be somewhat more difficult than their original versions.

Although Perlman and McCann say that in their experiences, students do not typically miss exams in order to have a longer period of time to study; the fact remains that students taking make-up exams do have a longer period of time to study. They also have the opportunity to discuss the exam with other students. Thus, it seems appropriate to produce a make-up exam that is to some degree more difficult than the original version in order to achieve an equitable arrangement. Some instructors may also, with justification, suggest that make-up exams should have higher difficulty levels to serve as penalties for missing the original exams. We are, after all, working toward the long-term goal of training students to function well in their careers. The ability to meet deadlines seems an important aspect of success in any career path. I doubt if students are harmed by learning that missing deadlines results in additional time and effort in order to “catch-up” with their peers.

It is not unreasonable for instructors to consider the use of essay make-up exams as a deterrent for students missing exams. I teach a large general psychology course, often with an enrollment of 600 or more students. In doing so, I believe that it is desirable for college students to acquire experience with classes of various sizes, as a means of training them to adapt to any future requirements of their careers. I would like my students to “learn to learn” in any type of setting; there are important skills to be acquired in small seminars and large lecture halls, as well as the more moderate-sized classes. Thus, over the years, I have had hundreds of conversations with students who were in the process of making decisions about missing exams in my general psychology courses. The essay make-up policy has clearly served as an effective deterrent for students who have considered missing class for reasons that they ultimately judged to be less important than performance in the course. This decision-making process, with the essay make-up policy clearly stated on the syllabus, as well as discussed in class, is probably in itself an educational experience that will be repeated in students’ future careers, as they attempt to balance the demands of work, family, and often — their desires for vacations and other forms of entertainment.

My only real concern about this course policy is that students may view the essay make-up exam only as a punishment, rather than an opportunity to demonstrate their knowledge and skills in an alternate format. The essay exam is actually an excellent format for testing that can assess knowledge at a deeper level than multiple choice tests (e.g., recall vs. recognition) and it is my hope that students will be tested in this format many times in their college careers. In recent years, I have attempted to counter the negative view of essay exams (i.e., as punishments) by asking students to speak to me before they take the essay make-up exams. In these conversations, I describe the requirements of essay test-taking, provide study tips, as well as examples of the essay questions that students may encounter on my make-up exams.

I am now (in part, due to the Perlman and McCann article!) considering methods to make this procedure a more systematic element of my general psychology course. It seems to me that an essay make-up exam, while serving as an effective deterrent for students missing exams in large courses, also provides an opportunity to enhance the student’s educational experience. When a student misses an exam, the situation can be used to promote individualized instruction, helping the student master the skills necessary to demonstrate an appropriate knowledge of the course curriculum.

—Su L. Boatright-Horowitz
University of Rhode Island