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Keywords: Self-care, health information technology, e-patient.
Citation: Greene A, Greene C. Tom Ferguson’s triangles in the 21st century: an initial proposal. J Participat Med. 2013 Nov 27; 5:e40.
Published: November 27, 2013.
Competing Interests: The authors have declared that no competing interests exist.

In 1995, at the dawn of the World Wide Web, Tom Ferguson, MD, presciently proposed that the Information Age was poised to turn health care on its head. In the Industrial Age, the focus of health care was primary, secondary, and tertiary care. But he recognized that what people thought of as the health care system was only the tip of a pyramid that rested on the much larger hidden base of medical self-care. As he put it in 1985, “You are already your own doctor….Research shows that people provide their own illness care between 80 and 98% of the time….[1]” He argued, “Self-care is — and has always been — our predominant form of health care.” And that “Our most powerful health resources are our spouses, families, friends, social networks, and communities.” Nevertheless, professional care was seen by most as the pinnacle, if not the sum total of care.

Greene Figure 1

With the advent of the web providing unprecedented access to health information, health care would flip with individual self-care, friends and family, and support networks coming to be seen as the most important sources of care.

Greene Figure 2

Now, almost two decades later, the Participation Age is gaining speed. The triangles are holding up, and then some.

Along came Facebook, Twitter, Google+, and other social media. Along came global mobile connectivity. And along came the beginning of a stream of mobile-connected health and medical monitoring devices such as those from FitBit, Withings, Cellscope, Scanadu, and AliveCor. The large parts of the new triangle afford even greater opportunity than could be seen before these developments.

Arguably, the small parts of the triangle are expanding as well with new technologies, including the science of genomics, and most recently with the Patient Protection and Affordable Care Act inviting millions more people into the professional care system.

An Initial Proposal

While the outline shape of the triangles holds true after nearly two decades of accelerating disruptive innovation, we’re beginning to see more and more cross-cutting between levels. This is a welcome change.

Technology is allowing professionals to have a voice helping to inform even individual self-care on the go. And friends and family can play an important role even in the ICU.

One powerful way to foster this participation across levels of care would be to create a culture where it is expected that patients, family, or patient advocates have real-time access to hospitalized patient’s medication record and would be encouraged to initial every dose of medication given during their stay. This provides an unequaled moment of education, preparing the patient network to understand and implement care after discharge. It also welcomes an unpaid external audit with a vested interest as a safety check to monitor and reduce medication and prescribing errors. Medication errors are an alarming systemic problem and perhaps the most important patient safety errors. [2]

The triangles are growing. The triangles are flipping as Tom Ferguson, MD predicted. It’s now time for the horizontal lines within the triangles to flip as well, welcoming professional and personal participation across the continuum of care.


  1. Ferguson T. Medical self-care: the seven rules for better health. Mother Earth News. July/August 1985. Available at: Accessed October 30, 2013.
  2. Greene A, Greene J. Medication errors result from current medication reconciliation practices: it’s time to adopt participatory reconciliation. J Participat Med. 2012 May 7; 4:e11. Avalable at: Accessed November 6, 2013.

Copyright: © 2013 Alan Greene and Cheryl Greene. 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.