By Susan Carr

The increasingly active role played by patients may be the biggest story in healthcare this year. From the participation of individuals from the WHO Patients for Patient Safety and the Pan American Health Organization at the National Patient Safety Foundation's Annual Congress, to the Joint Commission's publication of Patients as Partners: How to Involve Patients and Families in Their Own Care, to Steinbrook's article, "Imposing Personal Responsibility for Health," in the August 24 issue of The New England Journal of Medicine, I have been constantly refining my definition of patient-centeredness based on new experiences and information.

There was a time when I thought patient-centered referred to clinicians acting with sincere and enlightened interest for their patients. Now I see all aspects of healthcare — medical, financial, political, ethical — infused with the patient as an active agent with significant rights and responsibilities.

Patient-centered has come to mean many things, from full participation in medical decisions, to exercising financial responsibility, to insuring the quality and safety of care. The actions that patients now take include the following:

• Supplying physicians with a complete list of the medications and supplements they take, in addition to their personal and family medical histories.
  
  
• Collaborating with clinicians in "shared decision-making" that takes the patient's values and lifestyle into account.
  
  
• Complying with care plans.
  
  
• Reviewing personal health records through online portals or Web services.
  
  
• Reminding clinicians to wash their hands before delivering care.
  
  
• Acting as an advocate for a friend or family member who requires inpatient care.
  
  
• Calling for a rapid response team for a patient in decline.
  
  
• Confirming that the planned site of surgery is correct.
  
  
• Managing direct payment for healthcare services through high-deductible insurance plans and health savings accounts.
  
  
• Choosing physicians and hospitals based on publicly available quality indicators.
  
  
• Serving on hospital Advisory Boards.

The phrase "paradigm shift" is tainted from over- and mis-use, but it may be appropriate in this case. Both as an editor and a consumer, I see a new worldview in healthcare that is inspiring and challenging. While there is great improvement, some of these developments — especially changes in payment — may actually isolate or abandon patients when they are most in need of support and guidance. The trend bears careful thought. I encourage readers with ideas about the evolution of the patient's role to send me a message at susancarr@psqh.com. I'd love to hear your thoughts.