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Keywords: Participatory medicine, concierge medicine, digital divide, uninsured patients.
Citation: Graedon J, Graedon T. Participatory medicine: must you be rich to participate? J Participat Med. 2012 Feb 1; 4:e2.
Published: February 1, 2012.
Competing Interests: The authors have declared that no competing interests exist.

“Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.[1]”

Our lofty definition of participatory medicine requires patients who are both interested and capable of taking an active role in their health care as well as providers who have time to listen and work together in a partnership with patients.

We fear that this movement may be leaving too many people behind. Those without insurance are rarely in a position to participate fully in their health care. When problems arise, the emergency room is far too frequently the only access such patients may have. That is not a great place to initiate participatory medicine, especially if you are in distress.

Providers frequently complain that their biggest challenge is time, whether in the ER or in the clinic. They just don’t have enough time to listen to a long story; do a complete workup; review all medications for incompatibilities; and counsel the patient on lifestyle issues, treatment options, and what to expect from a new prescription.

The exception to this model is concierge care. In this approach to health care, time with the patient is at the top of the priority list. Many such practices promote the possibility of patient empowerment and personalized care. The only hitch is the personalized bill, which can start around $1500 a year and go to several thousand dollars per patient. This doesn’t include any tests, procedures, specialists, or hospitalization. It gets the patient same-day or next-day appointments, 24-hour access, and unhurried visits.

If you think of health care as if it were air travel, the difference between a regular doctor visit and a concierge visit is a bit like the difference between coach and first class. First class passengers board first, have room for their luggage as well as their legs, are treated respectfully, and get served “free” beverages and food. In coach you’ll be lucky to find room in a bin for your carry-on, you will be squeezed into a tiny space with no legroom and the flight attendants may seem overwhelmed and impatient.

We don’t doubt that people who are able to pay thousands of dollars out of pocket just to get in the door of a patient-centered medical practice could be getting a more personal relationship with their physicians. Not only are they getting more time and attention, they probably have the skills and resources to negotiate a partnership before they even walk in the door.

Most of us cannot afford concierge medicine — or concierge hospitals featuring privacy, gourmet meals, and luxurious bathrooms — any more than we can afford to fly first class. That’s doubly true for poor people, who often take the bus because they can’t fly at all. In many cases, they can’t even afford insurance that would provide minimal health care. As a result, they often end up seeking care in crowded safety net clinics or emergency rooms where there is precious little time to consider empowerment or engagement. Is the participatory medicine movement leaving them behind?


  1. Society for Participatory Medicine. Available at: Accessed January 28, 2012.

Copyright: © 2012 Joe Graedon and Terry Graedon. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.