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The Reality Of Participatory Primary Care

No matter where one stands on appropriateness and advantages of each patient being involved in self-diagnosis and treatment of their own medical problems there are two inevitable conclusions:

•    First of all, self diagnosis and treatment are as natural as breathing and as impossible to extinguish as thought itself.

•    Secondly, given today’s healthcare system, there always will exist a dynamic tension between self-determination of the individual patient and the powerful healthcare system which often insists on patients falling back in line and complying with orders.

Few would argue against the need for a powerful alliance that embraces the benefits brought to the table by both the practitioner and the patient. Simplistically, the physician would carry the role of healthcare consultant and guidance while the patient ultimately becomes responsible for the choices.

Yet, realistically, the power curve lies extraordinarily in the hands of the medical professional. Not only does the illness place patients and their families in a vulnerable and poor negotiating position but practically nothing can legally occur — no meds, no tests, no x-rays, no referral until the physician gives the nod of approval. Irrespective of the patient’s self-diagnosis, whether it is simple or complex, right or wrong, risky or not, the patient must submit to and endure “the system.”

If the patient chooses not to go down the traditional path within the system, then she must seek solace in the hands of the alternative practitioners that legally exercise freedom of speech over scientific rigor while appealingly encouraging patient self-empowerment over paternalism.

Perhaps no better place in modern healthcare exemplifies the need for a powerful and trusting relationship between self-empowerment and distilling the usually paternalistic system than in primary care. It is with the day-to-day health issues dominating primary care that our patients feel their most confident in self-diagnosis. Yet our patients need the insight, know-how and experience of our practitioners to come to the best medical diagnosis and course of action for them and then to help them implement their treatment plan.

The focus on the patient — and their input and participation — has always been at the heart of our practice. It is what leads to healthier and happier outcomes for nearly all.

Until next week, I remain yours in primary care,

Alan Dappen, M.D.

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