Comment on: Engaging Patients in Safety: Naughty or Nice? by Michael Millenson

Minimally disruptive medicine seeks to respect patients above all else, but what that means in practice is complex. Indeed, in its efforts to reduce the healthcare footprint on patients’ lives, MDM tries not to overburden patients with excessive healthcare tasks and responsibilities. At the same time, MDM aims to promote patients’ capacity to make decisions, take ownership of their health, and to do the things that bring meaning to their lives. Health care is serving patients well when it seeks to truly empower, engage, and activate patients to do the things that bring meaning to their lives. This terminology can be hijacked, however, to justify a transfer of work and responsibility to patients that primarily serves only the goals of health care itself. Such a maneuver is a disrespectful imposition on patients.

Michael Millenson is the president of Health Quality Advisors LLC, a leading thinker on patient-centeredness and quality in health care, and a valued member of the Minimally Disruptive Medicine Workgroup. His recent holiday-themed blogpost, Engaging Patients in Safety: Naughty or Nice?, is a thoughtful illustration of the ways in which efforts taken in the name of patient engagement can sometimes miss the mark.


The process of engaging patients in making care safer should be seen through a Santa Claus lens. It can be naughty or nice, depending not on good intentions but on the specifics of the intervention.

True engagement is collaboration; the rest deserves a lump of coal in the stocking.

Seeking True Empowerment

The key question is whether patients are being truly empowered or whether providers are passing the buck, placing on patients’ shoulders responsibilities that rightfully should reside elsewhere. It’s like those old Westerns where the sheriff hands rifles to a bunch of ranchers and tells them to form up a posse and ride with him after the bad guy. While it’s nice to be a valued part of the justice system, there’s a reason the local citizenry finally coughed up enough cash to pay for a real police force.


What shared decision making means to the patient

With shared decision making, patients have the opportunity to discuss their lifestyle and preferences with their physician (or nurse practioner or physician assistant) to make healthcare decisions that are right for them.  This can be especially beneficial to patients with chronic conditions.  In these videos, two Mayo Clinic patients share their personal experiences with shared decision making and how it has changed the management of their own health. 

Educational resources for patients

Mayo Clinic patients have access to a broad array of healthcare education and counseling services through the Barbara Woodward Lips Patient Education Center, which enables them to be partners in their health care.   The Center makes efforts to reach diverse audiences, as seen in its new design for teen patient education material. 

In this video, patients and staff discuss the Barbara Woodward Lips Patient Education Center:

The value of an unhurried conversation

by Victor Montori, MD (Wiser Choices Program)

As we reflect on the present and future of healthcare, it is key to consider the value of an unhurried conversation.

At the Mayo Center for Innovation 2009 Symposium, Maggie Breslin made a compelling case to focus on conversations as a key strategy to improve healthcare.  Watch her inspiring and inspired proposition here.

Becca Camp, a visiting student at our KER UNIT, recently wrote a blog post of an experience at Mayo Clinic she was privileged to witness.  In it she noted the relationship between an unhurried conversation and the opportunity to contextualize care to a patient’s specific situation, a requirement of both evidence-based practice and patient-centered care.  A recent rigorous and careful study documented how failure to pay attention to context can lead to poor quality care.

Don Berwick in his address to the Yale Medical School 2010 Graduating Address, he noted the critical importance of patient-centered care and the role that clinicians can play in treating patients with respect and humanity, urging them to

…recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul.

Meantime, we seek to measure value in healthcare and we find it difficult to articulate how to capture the value of the unhurried conversation.  How do we know that our systems promote these conversations?  Should we protect these, and if so how, when economic considerations (payment, demand, access) threaten them?

The unhurried conversation, a key component of the Mayo Model of Care, should be the focus of intense investigation.  How much time is necessary to achieve this experience?  How should care professionals be trained to participate?  How do new requirements for healthcare provision affect these?

I believe it will be up to patients — thru a strong patient movement — to make sure the unhurried conversation remains a possibility as healthcare changes.  And it will be up to us to provide the resources and knowhow to realize that possibility.