ABSTRACT
Healthcare has historically been organised around the needs and convenience of the experts and assumed that patients would find their way to the place where clinical knowledge resides. This model of patients as supplicants and physicians doling out advice based on their expertise has been challenged by the growth of alternative and complementary medicine, and the acknowledgement of patient expertise particularly in relation to long-term conditions. A second set of challenges to this model has come from the state as a primary funder, and often employer, of health professionals, and as part of larger, often neo-liberal-inspired managerial reforms that have sought greater accountability. A third source of challenge to traditional models of medical hierarchy and control has emerged from the public as – citizens and taxpayers who have asserted the need for responsiveness to the views, expectations and needs of the population rather than those of government or clinical experts. Together these challenges have shifted traditional models of medical hierarchy and are redefining the meaning of patient-centred care through calls for greater involvement of patients in decisions about their own healthcare and public inclusion in the evaluation and development of health services and research as a way of shaping and prioritising the knowledge base.
