4: The new medical paradigm

The 21st century requires not simply another reorganisation but a transformation of the way in which medicine is practised and healthcare delivered - a transformation of the health professions, healthcare organisations, and patients. Furthermore, it would not be appropriate to polarise patients and clinicians even further because, although each needs to change, perhaps the most important change necessary is a shift away from the assumption that only the clinician is competent and must bear responsibility for decision making and care organisation. The new paradigm is one in which responsibility and control are shared at a level to be negotiated with each patient. In this final section of the book, the shape of 21st century healthcare is described with respect to:

• patients
• clinicians
• organisations

Finally, a move to shared decision-making is promoted.

4.1 21st century patients - resourceful with responsibilities
4.2 21st century healthcare organisations - patient-centred organisations
4.3 The 21st century clinician - the complementary clinician
4.4 Shared decision-making and patient-centred care