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    Power to the Patient!

    Levinson notes that patients come in to their doctors' offices with expectations and beliefs about what will happen. For her, the issue is a practical one: how will the doctor and patient negotiate differences of opinion?

    "One of the strategies I really have enjoyed using is asking the patient about the invisible third person in the room," she says. "That is the person who before the patient came to the doctor said to them, 'Remember to ask about such-and-such.' I like to ask patients, 'who do you talk to about your healthcare.' And they say, 'Well, I talk to my Aunt Marge, she's a nurse.' And so I say, 'What do you think Aunt Marge might think about this therapy we are talking about?' That sounds convoluted, but it is a lot easier to disagree with the doctor through an invisible third person and challenge what the doctor is telling you by saying your Aunt Marge might not agree with the treatment plan."

    Suchman advises patients to think hard not only about what they want to get from their relationships with their doctors, but what they are willing to contribute.

    "The first thing is defining your own values, then being willing to step up to the process of partnership [with your doctor]," he says. "You have to be willing to advocate for what you are looking for, to give feedback to your doctor -- to help your doctor help you the way you like to be helped. If someone just says they don't like the way I communicate, I don't have the chance to change. But if a patient tells me that I made a mistake and I respond to that, it is a moment of truth. I can build more trust than if I didn't make a mistake in the first place. So instead of taking the passive role of patient, people should be willing to play a more active role, and then see how the doctor is willing to respond.

    "The point of this is for patients to use their power," Suchman continues. "Patients have a lot of power -- not total power, but what they have now has to get a lot stronger. But even at the individual level people have the power to change the kind of care that they get. People need to understand that they are the first person in charge of their health. It is not their doctor, not someone else. They must recognize this role and actively think about it."

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