What are the requirements to deem someone a patient?

Defining a Patient in Healthcare

A patient is a person receiving healthcare attention or using health services who is the subject of medical decisions, regardless of whether they have an active health condition. 1

Core Definition

The most pragmatic and widely applicable definition comes from recent international guidelines:

• A patient is defined as a person (or their digital representation) receiving healthcare attention or using health services and who is the subject of decisions made with support of healthcare systems. 1
• This definition explicitly acknowledges that someone with no active health conditions who receives care for preventative purposes or health optimization is still considered a patient, even though they may not be "ill" in the traditional sense. 1
• The term encompasses individuals, families, or groups with multiple human needs that vary based on their characteristics, health/illness state, and care setting. 2

Presumption of Capacity

Adults are presumed to be patients with full decision-making capacity until proven otherwise. 1

• Every adult patient is presumed to have capacity to make decisions about their care and treatment, including the right to agree to or refuse any intervention. 1
• This presumption applies regardless of age, and patients do not need to provide evidence of their capacity to make medical, financial, legal, or personal decisions. 1
• A person can only be considered to lack capacity once it is demonstrated that they cannot understand, retain, use/weigh information, or communicate their decision. 1

When Capacity Is Questioned

Capacity assessment is decision-specific and requires evaluation of four distinct abilities: understanding, appreciation, reasoning, and expression of choice. 1

The Four Required Abilities:

• Understanding: The patient must comprehend basic relevant information including their condition, proposed intervention, alternatives, and risks/benefits of each option including no treatment. 1
• Appreciation: The patient must acknowledge their medical condition and probable consequences of treatment options. 1
• Reasoning: The patient must weigh risks and benefits and reach a decision consistent with that assessment. 1
• Choice: The patient must express a decision indicating their preferred treatment option. 1

Important Nuances:

• Capacity determinations are made by clinicians in most circumstances, not lawyers or judges, yet these clinical determinations carry profound legal consequences. 1
• Cognitive impairment exists on a spectrum—a patient may lack capacity for complex decisions (financial investments) while retaining capacity for simpler matters (grocery shopping). 1
• A finding that a patient lacks capacity for one decision does not imply they lack capacity for other decisions with different cognitive demands. 1

Patient Status Across the Care Continuum

The term "patient" applies throughout the entire disease trajectory, from diagnosis through cure or palliation. 1

• A cancer patient, for example, remains a "patient" whether waiting for treatment, receiving active therapy, on symptomatic treatment, or receiving palliative care. 1
• Patients cured from their disease transition to being termed "cancer survivors" rather than "patients." 1
• The patient designation covers neoadjuvant, curative, adjuvant, and palliative treatment phases, with care concepts adapted accordingly. 1

Practical Implications for Care Delivery

Patients have identifiable, measurable needs that must be systematically assessed and documented. 3, 2

Ten Core Patient Need Categories:

• Communication, basic care, contact with others, staff behavior, empathy, competent caregivers, continuity, integrity, participation in decision-making, and pain relief. 3
• These needs are psychological, physical, and social in nature, with dynamic interaction between these domains. 2
• Patients have varying abilities to ensure their needs are met—some openly seek attention while others avoid disturbing staff. 3

Documentation Requirements:

• Accurate and complete documentation from therapists or referring physicians is required for determination of medical necessity for continued services. 4
• A systematic method of learning about the patient and basing care on their specific needs is essential. 2

Common Pitfalls to Avoid

• Do not make sweeping global determinations of incompetence. The older all-or-none approach has been replaced by decision-specific capacity assessments. 1
• Do not assume capacity is permanent or temporary based on diagnosis alone. Impairment or disturbance affecting the mind or brain can be either permanent or temporary, and capacity must be assessed for each specific decision. 1
• Do not confuse patient wants with patient interests. When patients have given no mandate for others to decide, their own values should prevail, requiring extensive communication to establish what patients actually want. 5
• Do not overlook social and nonclinical criteria. Pain, potential abuse, communication barriers, age, and special needs may justify care even when clinical criteria alone might not. 6