Towards the patient revolution

Patient empowerment and involvement - motherhood and apple pie - what's not to like? The problem becomes that, once you go outside the individual doctor-patient relationship, it is necessary to be very careful about the balance of any group that purports to determine patients' interests as a whole.

This is illustrated in the field of disability, where a great deal of policy has been developed to meet the perspective of highly competent people who have physical disabilities and have found themselves marginalised in the past by lack of access and inappropriate assumptions. Their perspective is legitimate, insofar as it relates to their own situation, but has been used to try to impose policies such as inclusive schooling, supported living, and personal budgets on people with completely different needs, regardless of whether they are meaningful for them.

Another point to be wary of is that patient and patient advocate views may only be considered to be a good thing, if they support the agendas of those in power - i.e. lots of warm words about compassion and communication, quite a bit about abjuring the medical model and rejecting paternalism, but not so much about being allowed access to specific treatments.