Roles, power and subjective choice.

This paper examines the history underpinning the development of patient involvement in the decision-making process and the emergence of choice in the management of their illness. From the beginnings of the National Health Service (NHS) in United Kingdom, power, and therefore decisions, were in the hands of a well-organised and structured medical profession. With the dominance of a biomedical model of health care 'patient power' was subsumed by that of 'experts' in various emerging fields. Over the past 10 years however, in response to top down and bottom up decisions, evidence and a changing culture, a process of partnership is emerging. Such a philosophy enhances the value given and attached to all who participate. A new generation of patients have been brought up under the umbrella of the NHS, they have access to complex and detailed information and they have legally embedded power to participate in decisions that affect them. The culture of medicine is changing but if this new agenda is to have real meaning and make progress it must be embraced by all sections of society.