Intended for healthcare professionals

Analysis Essay

When “patient centred” is no longer enough: the challenge of collaborative health: an essay by Michael L Millenson

BMJ 2017; 358 doi: (Published 05 July 2017) Cite this as: BMJ 2017;358:j3048
  1. Michael L Millenson, president1
  1. 1Health Quality Advisors, Highland Park, IL, USA
  2. 2Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
  1. mm{at}

Patient centred care is being subsumed by collaborative health, enabled by sweeping technological, economic, and social changes. Doctors are losing some of their power and will have to alter their behaviour to retain public trust, writes Michael L Millenson


Michael L Millenson is a writer, consultant, researcher, and activist for better, safer, and more patient centred healthcare.

His book Demanding Medical Excellence: Doctors and Accountability in the Information Age achieved critical acclaim. As a healthcare reporter for the Chicago Tribune earlier in his career, he was nominated three times for a Pulitzer prize.

A quarter of a century ago, researchers proposed “patient centred care” as a conceptual framework that “consciously adopts the patient’s perspective” about what’s important in interactions with providers and institutions.1

Today, technological, economic, and social changes are moving healthcare in directions unanticipated by the patient centredness pioneers. It’s not that patient centredness no longer pertains; rather, it’s being subsumed under these larger forces reshaping 21st century medicine. I suggest “collaborative health” as an umbrella term framing how clinicians should respond.

The Victorian parliamentarian and novelist Edward Bulwer-Lytton declared, “A reform is a correction of abuses; a revolution is a transfer of power.” Patient centred care began as a correction of abuses, a response to patients being treated like “imbeciles and inventory.”2 Decades later, what’s claimed to be patient centred still too often reflects a paternalistic attitude, ironically expressed by comedian Stephen Colbert in a different context on the Late Show in 2015: “See what we can accomplish when we work together by you doing what I say? It’s called a partnership.”

In contrast, collaborative health describes a shifting constellation of collaborations for sickness care and for maintaining wellbeing that is shaped by people based on their life circumstances. The result is not reform, but a …

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