Thanks for this. I'd say these are reviews taking place in a clinical setting and geared toward generating a care plan with a time frame of some length. Under these conditions, we could expect a patient to be laboring under the fewest possible distractions and as such be the best candidate for supervising one's own care.

But it is seriously wrong to assume the patient will continue to act akin to a corporate employee bloodlessly toiling on a project at work. It is far more likely that the patient will at some point begin to act like a person with discomfort, with all the accompanying bewilderment, skepticism, confusion, hypersensitivity, etc. This reality needs to be honored, not waved away.

Again, I do advocate for educated and engaged patients, but I totally reject the idea that systematically these patients are to be depended upon for engagement in their own care to the degree that any medical errors can reasonably be precluded by such engagement. Not only does it fly in the face of psychological realities of patients, it appears to me to be an ugly slippery slope toward the direction of general victim-blaming and "externalization" that the corporate ethos is so well known for.

My own experience has been that engaged patients get the best outcomes and that healthcare is so complex that only the patient can really control what is going on. This is no different from my clients in technology consulting - only the truly engaged clients get what they want.