Citizens, particularly those who become patients, need to recognise their own individual responsibility to bring about `partnership-healthcare` that has been found to be both satisfactory and satisfying for both parties in the unique doctor-patient relationship within consultations, and elsewhere with other health professionals.

There are numerous productive roles for individual patients (and their carers) who aspire to improve the millions of dialogues that occur. Patient and public involvment in research is a reality – in this SDM area and in others; people can contribute individually or in groups; directly or facilitated. Rigorous qualitative research methods enable people to contribute to improving the quality of research that should inform all decisions. Examples of this are the ProtecT trial; the Department of Health Health in PartnershipShared Decision-Making and Risk Communication in General Practice trial; the Thrombolysis trial – as reported by Koops and Lindley in the BMJ.

More action and better promotion (`selling the idea`) to THE GENERAL PUBLIC – i.e. those citizens who foot the bill in the UK for our NHS – would be a big step in the right direction. It is they who should seize the initiative – it`s THEIR health service! They don`t need to wait to be asked……

In other types of major decision we're usually treated like grown-ups, trusted to make appropriate choices when given information about our options, for example when buying a house or choosing a pension. But informed, activated patients are still seen as a threat by many doctors, and those who want  reliable evidence-based information about treatment options have to look elsewhere for it. 

Isn't it time that Royal Colleges, medical societies and other clinical groups  seized the initiative? They should be actively promoting more up-to-date attitudes among clinicians, demystifying medical knowledge and publicly acknowledging that patients have a right to participate in decisions that affect them directly.