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Patients and Clients

Alex S. Tulsky, MD
JAMA. 1982;247(9):1279. doi:10.1001/jama.1982.03320340037029.
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It is my custom, when I come on a floor of the hospital, to take the appropriate nursing charts and to direct my attention first to that section labeled "Nursing Notes." This quickly tells me what each patient's course has been in the previous 24 hours, after which I review more leisurely those sections dealing with laboratory analyses, house staff progress notes, and the like. I have been startled, in recent months, to learn from the nursing notes that my "client" did or did not void, was or was not febrile, that my "client" was or was not in pain, or that my "client" was ready for discharge in the morning. It disconcerted me to find that the patients I have taken care of for many years have magically become "clients." I had always known that lawyers, architects, and businessmen had clients to deal with, but the uniqueness of the


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