Remaking our system is a noble, grand struggle, one of the most important tasks for this century. Remaking is already going on in different ways. Obviously, there is health care reform, by which is meant legislation and executive action. This is, mostly, top down. I am not a libertarian: there is nothing I find philosophically inimical about top-down change. Health care is huge and someone has to flip the master switches.
At the same time, however, change has to come from the bottom. Patients are their own people with adequate decision-making capacity: can you believe that some doctors are only just coming around to this truth? But how do we get the system to embody this truth? We can not legislate shared decision making and patient-centeredness; nor can we merely, by fiat (as some e-patients are doing), say that patients are now the owners of the store.
Patients should be the owners of the store, together with their doctors, but just proclaiming that in a loud voice won't get you anywhere. Some of us live out in the woods, where Internet calls-to-action don't carry, and some others of us are too disempowered or intimidated to take charge in our doctors' offices even if we are given permission to by those well-spoken advocates.
I like to make the comparison to the struggle for civil rights, which I am no historical expert in (so correct me if I am wrong). That struggle's success was dependent on both legislative action and bottom-up activism, each of which informed the other. The exercise of the right to vote would not have been possible without the Voting Rights Act. The Voting Rights Act would not have worked without protests.
There is a place for health care reform to encourage primary care providers to establish a relationship with patients, and vice versa. But the importance of communication to such an endeavor, I can't help but think, is not something that will come out from Washington. That will have to bubble up out of each exam room individually.
Tomorrow's the big day! Please - if you have read the book already - review it on Amazon or Goodreads. If you haven't read it, you are warmly invited to do so. Even more important than buying the book is letting me and others know what you think about it.