Patient activation: Microdemocracy at work in the community

Microdemocracy seeks to help individuals participate effectively in decisions that affect them in encounters with public agencies. In health care this takes the form of patient activation which reflects the belief that one's behaviors are important contributors to health outcomes. Underrepresented minority and lower socioeconomic status (SES) individuals have lower levels of activation which may contribute to disparities. Physicians communicate less collaboratively with patients who ask fewer questions thus teaching patients to ask questions may improve communication and help address disparities. We developed a brief intervention designed to help patients prepare for their visit with a health care provider and to reinforce the message that their participation is necessary for quality health care. We have trained medical students learn to deliver this intervention in Patient-Centered Medical Homes in New York City. Students receive a single workshop as part of their interviewing skills curriculum and the interventions are “service learning,” a contribution that they make to show appreciation for the sites and patients that contribute to their education. We have demonstrated that students who participate understand patient-centered interviewing better. Students approach patients in the waiting room, helping them to use otherwise unproductive time and generate a prioritized list of 3 questions to be discussed during their health care encounter. Patients learn to distinguish between open and closed ended questions and the type of information the answers to each will generate. We will describe the intervention, the training model, and discuss the differential effects of the intervention in language discordant physician-patient relationships.