Participatory Medicine

For hundreds of years, the physician-patient relationship has seen the physician as the authoritative, sometimes dictatorial, healer — the unquestioned expert on care, protocols and medical regimens. The patient assumed the role of a passive receiver of information, taking orders and instruction from the doctor. Today, there is a movement afoot — one that is welcomed by me and many of my colleagues. It’s a change that I hope will become the norm when it comes to the physician-patient relationship. It’s all about partnerships between patient and provider. Participatory medicine, as noted by the Society for Participatory Medicine (S4PM), is “a movement in which networked patients shift from being mere passengers to responsible drivers of their health and in which providers encourage and value them as full partners.” The society further states, “Participatory medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual's health.” I encourage my colleagues and medical professionals across our region to embrace the participatory medicine movement. My introduction to participatory medicine originated with Stanford University’s Medicine X conference. Medicine X is a Stanford School of Medicine initiative that explores how emerging technologies will advance the practice of medicine, improve health and empower patients to be active participants in their own care. This past fall, I was invited to speak there about the interconnected lives of patients and doctors. These interactions have inspired me to further pursue the concept of empowering patients as active participants in their own care. I believe that when health care providers empower patients to do so, we can achieve the best possible outcome for each individual. The participatory medicine movement can document these improved outcomes, such as reduced medical errors and increased patient satisfaction and empowerment in their health and wellness. As a cardiac surgeon, I have become aware of how intimidating surgeons can be to many patients, because of both the high impact we have on their lives and the invasive nature of surgery, even minimally invasive surgeries. Because of this, many patients feel they cannot question me about their treatment plan or discuss information they have discovered while researching their heart condition. I have recently been part of a “flip the clinic” project, which endeavors to reimagine the medical encounter between patients and care providers (along the lines of Khan Academy’s “Flip the Classroom”). Included in this project are materials that help patients focus their questions during a visit so they can be sure their message is delivered. It also includes “knowledge” prescriptions as well as a “farmers market” prescription to aid in starting on a better diet. Physicians and the entire medical team need to shift to a patient-centered focus and approach patient interaction with the goal of understanding what matters to each patient. Basically, we need to become much better listeners and teachers. A primary function of the physician should be to deliver the knowledge, resources and skills that will enable patients to make informed medical decisions, thereby empowering them to become active participants in determining their own outcomes. By playing central, meaningful roles in their medical care, patients are far more likely to establish — and accomplish — their health and wellness goals. One great message I received at Medicine X was an encounter with an e-patient who was concerned that frequently she would leave a physician visit with the feeling that the doc did not “get it” regarding her fears and concerns. I now ask all my patients, at the end of our visits, “Did I get it? Did I successfully answer your questions and address your fears?” My hope is that they can now leave the appointment comfortable that all questions and concerns have been properly addressed. I supply references, both text and web-based, all in an effort to help my patients become better informed and more active and engaged in their health. I also encourage our academic medical centers to embrace the participatory medicine movement and to introduce courses in medical schools to ensure the next generation of physicians enters practice knowing the benefits of forming partnerships with their patients in their health care journey.