Listening and Breaking Down the Walls

At a time when walls seem to be rising higher inexorably between patients and clinicians, two strategies may stimulate change and lead to health care systems very different from those currently in place. The first is to bring organized, structured feedback systems into place, with patients and their families serving as expert witnesses to their care. The second is for patients and health professionals to join in designing, implementing, and monitoring new ways to improve quality and shared decision making. The challenge for patients and clinicians is to deal with the ongoing loss of both time and privacy, while preserving a reasonable professional and personal quality of life.