By Susan Carr, Editor

Increasingly, healthcare consumers engage with clinicians and administrators in discussions about improving the safety and quality of healthcare. There are obvious topics that must include patients and their families, but I see examples of consumers joining the discussion in a broader role that indicates just how much (if slowly) the world is changing. Much of what I see is facilitated by the Internet.

I'm reminded of a cartoon by Peter Steiner, published in The New Yorker in the early 1990s. Two dogs sit at a computer. The one with his paw on the keyboard says, "On the Internet, nobody knows you're a dog." Well, they may not be able to tell if you're a patient, either.

I recently received an email message from the Center for Connected Health announcing their new web site (www.connected-health.org). Director Joseph Kvedar, MD, says, "The site is designed to create a dynamic community where clinicians, healthcare administrators, technologists, payers, and patients can share ideas and best practices. We encourage visitors to ask the tough questions and learn how consumer-ready technologies can help to improve healthcare delivery..."

Another especially interesting example of consumers participating in the discussion is on Paul Levy's blog called Running a Hospital (http://runningahospital.blogspot.com). Levy is president and CEO of Beth Israel Deaconess Medical Center in Boston. He posts regularly and — even more impressive — responds promptly to comments. His readers include all kinds of people interested in healthcare, including patients, and they ask thoughtful, well-informed questions. Levy's site provides an open-ended discussion in a refreshingly open, respectful, and trusting environment.

And in non-virtual discussions, advocates for patients and their families played a prominent role at this year's Quality Colloquium (www.qualitycolloquium.com). On the first morning of the Colloquium, Helen Haskell, founder and president of Mothers Against Medical Error, gave a plenary presentation on the patient's role in patient safety. At midday, Tom Delbanco, MD, introduced a video he wrote and directed for CRICO/RMF, When Things Go Wrong: Voices of Patients and Families. And on the second day of the Colloquium, one of three half-day tracks offered eight talks about patient stories and adverse event disclosure.

Speakers representing the consumer's viewpoint in a conference setting of this sort — where everyone knows you're a patient/victim — are sometimes limited by stereotypes, but increasing opportunities to participate should continue to widen the discussion.