Health Care Professionals Return to the Nation of PeoplePower

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Mar 10, 2017
by Oscar Tollast
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Health Care Professionals Return to the Nation of PeoplePower

Fellows convene in Salzburg for opening day of Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship Dr. Tom Belcano (left) and Salzburg Global Program Director John Lotherington (right) Picture: Salzburg Global Seminar/Ela Grieshaber

Health professionals in Salzburg have been implored to create an "avalanche" of ideas linked to transparency and the future of medical records.

Clinicians, patients, health providers, and commentators are among those have gathered at Schloss Leopoldskron for the Salzburg Global Seminar session Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician.

The session, supported by OpenNotes, was kick-started on Friday afternoon with introductory speeches from the session's co-chairs Dr. Tom Delbanco and Professor Tobias Esch.

Dr. Delbanco, Koplow-Tullis Professor of General Medicine and Primary Care at Harvard Medical School, and co-founder of OpenNotes began by dedicating the session to Salzburg Global’s “fourth founder” Herb Gleason. Mr. Gleason was a major driving force behind a number of Salzburg Global's health care programs before he passed away in 2013.

Dr. Delbanco, a multiple-time Salzburg Global Fellow, then described what he hoped to achieve from the session. Likening it to an “avalanche,” he urged participants to come up with ideas for change to implement quickly.

His co-chair, Professor Esch, said he was keen during the session to focus on the patient and the relationships they have with the people who treat them. Having been involved in the topic for much of his life, Professor Esch said the session now provided a chance to sit down at the table and talk.

During the session, and among other topics, participants will consider what difference full transparency may make for patients and clinicians, with insights from the neuroscience of motivation and self-care, and patient-controlled health information.

The session aims to build on the work achieved at a Salzburg Global session held in 1998 called Through the Patient’s Eyes: Collaboration between Patients and Health Care Professionals

During this session, teams of health care professionals, patient advocates, and artists laid out the foundations for the country of “PeoplePower,” a country with a health system built “through the patients’ eyes.” In this scenario, patients and clinicians would both be encouraged to contribute actively to the patient record, demonstrating shared decision-making and governance. The session helped coin the patient empowerment phrase "Nothing about me without me."

Following the introductory remarks, Dr. Delbanco - chair of both that influential 1998 session and this 2017 follow-on - sat down with Salzburg Global Program Director John Lotherington to discuss PeoplePower’s history. He described people power as one of the least utilized resources, something which should be tapped into far more by health professionals.

Dr. Delbanco described the number of thoughts which came out of the 1998 session as “scary.” He said some of the electronic ideas suggested at the time were now coming “too fast.”

In addition, he claimed we still hadn’t reached a point where generic patients had a voice in the activities of health care institutions. Dr. Delbanco suggested shared decision-making, and patient power was a concept more talked about than something put into action.

Following this discussion, patients broke off into groups to discuss what they felt patients would want in a land called PeoplePower.

One table of Fellows highlighted a potential issue surrounding the assumption of having access as a patient. A participant argued a doctor should be inclined to ask their patient, “Have you accessed your notes? What did you think?" In response, Dr. Delbanco suggested patients were afraid of retribution if they challenged what their doctors told them.

Another table suggested rather than talking about the quality of health care, the conversation should be about the quality of health. Participants also considered how doctors and clinicians should respect cultural differences and account for them, with one suggestion being doctors should  “open their minds to the worlds patients bring into their practices.”

In addition to these talking points, participants considered what effect a direct line of contact between a doctor and a patient would have, and whether this would be taken advantage of. One table discussed a patient’s need to be heard, the need to communicate on an ongoing basis, and the concept of giving feedback.

Despite concerns being raised in some areas about this direct line of access, some participants did speak for it, suggesting such an act can demonstrate a mutual respect between the two parties. While more of a doctor’s time may be taken in the short-term, less time will be taken by the patient from the system in the future.

Participants will continue to discuss these ideas as the session progresses.


The Salzburg Global program Toward a Shared Culture of Health: Enriching and Charting the Patient-Clinician Relationship is part of the multi-year series Health and Health Care Innovation in the 21st Century. The session is being supported by OpenNotes. More information on the session can be found here: www.salzburglobal.org/go/553. You can follow all the discussions on Twitter by following the hashtag #SGShealth

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