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.