Public Participation in Medical Decision-Making: A Vision for the Future of Healthcare

In this ever-changing world, our lifestyles and worldviews have undergone tremendous shifts in just over a decade. The advent of the Internet has further accelerated this process of change. The sectors of commodity trading and services were the first to be impacted, followed by transformations in transportation. Even traditionally heavy industries such as education and healthcare have begun to undergo significant reforms.

Health and education are the prerequisites for ensuring social equity, democracy, and freedom, while transportation serves as a catalyst for societal prosperity. This article focuses on healthcare, attempting to explore the future landscape of the health industry through analogies with other sectors (with a primary emphasis on the medical sector within the broader health industry). Given the author’s limited expertise, readers are kindly invited to offer their corrections and insights.

Similar Histories, Different Trajectories

The development of the healthcare industry is, to a certain extent, highly similar to that of transportation and education.
As shown in the table:

The third stage corresponds to the modern era. During this period, access to hospitals, schools, and automobiles was restricted by high barriers, with services available only to a small elite at the top of society. However, as history progressed and human society advanced, these barriers gradually lowered. Eventually, car ownership became widespread, education became universally accessible, and people gained access to tertiary hospitals (Grade 3A hospitals). This democratization led to congestion across various sectors. To address this challenge, the transportation industry introduced public transit; the education sector divided comprehensive education into basic and advanced levels; and the healthcare system began experimenting with primitive forms of tiered diagnosis and treatment.

Currently, the education sector ensures universal access to basic education through multi-tiered educational systems and government mandates, while the development of the internet has enabled individuals with a thirst for knowledge to obtain advanced education and even professional skills training at low cost. The transportation sector is also addressing this issue by vigorously developing public transit and implementing administrative restrictions (which are, in fact, regressive), achieving certain results. In contrast, the healthcare sector faces more pronounced congestion due to the lack of significant differentiation in pricing across tiers (such as consultation fees at hospitals of different levels). Furthermore, the absence of a tiered diagnosis and treatment system has exacerbated the strain on China’s healthcare landscape. Perhaps the healthcare industry should learn from and draw upon the problem-solving approaches adopted by other sectors.

The Public's Choice

Suppose that everyone’s residence and workplace are only a 10-minute walk apart. If driving, the time spent on the road might be less than 10 minutes. Now, assume that everyone chooses to drive to work. Given the same distance, it would become impossible for anyone to complete the commute within 10 minutes. At this point, societal will begins to intervene, such as by implementing odd-even license plate rationing, prohibiting further car purchases, or charging fees for driving during certain periods—in short, by setting up barriers. In this scenario, rational individuals would likely give up driving and choose to walk to work instead.

In the healthcare sector, a similar yet more complex scenario arises. An individual presenting with cold symptoms registers for an appointment with a chief physician in the Department of Respiratory Medicine at Peking Union Medical College Hospital, waiting alongside patients with chronic obstructive pulmonary disease (COPD) or pulmonary masses. When asked to evaluate this situation, some members of the public may perceive it as a waste of medical resources, occupying opportunities that should be prioritized for patients requiring advanced diagnosis and treatment. Others may consider it necessary, given that cold-like symptoms can also manifest in severe diseases, thus warranting initial evaluation at a major hospital. Similarly, if everyone adopted the latter perspective, hospital overcrowding would inevitably occur; however, resolving this issue would not be as straightforward as in the first example, reflecting a current challenge facing the healthcare system.

Medical Decision-Making Capability

At this point, the general public needs to possess a certain capability, similar to how everyone in the first example could judge that “walking is the best solution.” In healthcare, this translates to the ability to make medical decisions. Simply put, it is the capacity to assess one’s own health status and choose appropriate solutions. Its essence is akin to the clinical competence held by physicians, albeit without requiring the same level of comprehensiveness and depth. With this capability, the public can reasonably handle situations like those described in the aforementioned examples.

Currently, most people possess this ability to varying degrees and engage in proactive learning. The most common example is searching on Baidu whenever health issues arise. Additionally, many people view and share various health-related articles on platforms like WeChat and Weibo. However, this type of learning is unsystematic, non-targeted, and fragmented, leading to insufficient capability when actual participation in medical decision-making is required.

Does this mean that ordinary people cannot acquire competent skills? Not at all. Human learning capacity is remarkably strong. In the early days of computing, without off-the-shelf software, every function had to be programmed by the operator. The capabilities of a computer were directly tied to the user’s programming skills, meaning only programmers could operate computers. However, the situation has changed completely. Today, most people possess the ability to use computers and can achieve even more functionality than professionals did in the past. For instance, individuals can now learn to use Meitu Xiuxiu within minutes, acquiring the ability to enhance images. The results are comparable to those produced by professional editors. Meitu Xiuxiu essentially transforms image-enhancement knowledge into automated functions. Users no longer need to master complex concepts such as levels, curves, saturation, and color balance; they only need to learn how to apply these features to achieve their desired outcomes.

There is no fundamental difference between acquiring the ability to make medical decisions and gaining the capability for image enhancement. In medical decision-making, essential knowledge includes clinical symptoms, physical signs, physiology and pathophysiology, pharmacology and toxicology, laboratory tests, imaging studies, and pathological diagnoses. It is difficult for laypersons to master this body of knowledge and its internal connections in a short period. However, if such knowledge were reorganized into functional modules akin to those in Meitu Xiuxiu (a popular photo-editing app), learning would become significantly easier for the general public.

So, what direct benefits can the general public gain from improved medical decision-making capabilities? Currently, the public’s primary concerns when seeking medical care are convenience and treatment efficacy. Let us propose a hypothetical scenario. Mr. Li has had cold symptoms for one week without treatment. Today, his condition worsened, and he decided to seek treatment. He first called his family doctor, Dr. Zhang, who inquired about his symptoms, identified several possible diagnoses, and advised him to go to a hospital for further examination. At this point, the story diverges into different paths: 1. Traditional Process: Mr. Li selects a hospital, waits to register, waits for the consultation, waits for examinations, waits for results, waits for diagnosis, waits to collect medication, waits to pay... 2. Optimized Process: Dr. Zhang schedules an appointment for Mr. Li. Mr. Li arrives at the hospital at the appointed time, receives his registration number immediately, proceeds to the consulting room, and then waits for the consultation, examinations, results, and diagnosis... 3. More Efficient Process: During the phone call, Dr. Zhang proposes a series of diagnostic tests. Mr. Li agrees and is willing to undergo them. He then goes directly to a third-party diagnostic center (or hospital) to complete the specified tests. Once the results are available, Dr. Zhang provides the corresponding diagnosis and treatment plan. After discussing it with Dr. Zhang, Mr. Li agrees to the proposed treatment plan.

If Mr. Li were a medical student, he would certainly opt for the third pathway, as his capacity for medical decision-making would facilitate smooth communication with physicians and enable him to assess the rationality of the proposed diagnostic and treatment plans. Third-party diagnostic centers or hospitals would also recognize the diagnostic decisions made jointly by the physician and the patient, thereby approving the necessary tests. This approach would reduce Mr. Li’s waiting time while conserving outpatient physicians’ resources. Admittedly, this applies to routine conditions; traditional methods remain necessary for complex, difficult-to-diagnose, or critical cases. However, when the majority of common diseases are managed through optimized pathways, more medical resources become available for traditional care processes, significantly enhancing overall efficiency—in other words, improving healthcare efficiency for the general population.

Consider another scenario: Ms. Wang, who desires pregnancy, is diagnosed with an ovarian endometrioma (chocolate cyst) following examination. Dr. Song recommends surgical intervention based on her condition. However, considering that her husband will not return to the country for another six months and mindful of the postoperative window for conception, Ms. Wang decides to defer surgery and instead opts for integrated traditional Chinese and Western medical conservative management. Dr. Song agrees with her decision. In this scenario, if Ms. Wang lacked adequate medical knowledge, it could likely lead to unfavorable outcomes. In this context, the patient achieved therapeutic benefits.

These are the benefits patients can reap once they possess the capacity for medical decision-making. When this capability becomes widespread among the general public, the entire healthcare system will undergo a genuine transformation—a positive one.

Conditions for Change

Using product manufacturing as an analogy, if doctors equipped with medical knowledge are likened to workers and health to the product, the current healthcare industry resembles a craft workshop where doctors strive tirelessly to “produce” health. However, once the general public acquires a certain level of production capability (i.e., medical decision-making ability), it is equivalent to a surge in the number of workers. In this scenario, doctors, leveraging their more specialized expertise, can transition into managerial roles, enabling each doctor to manage a multiplied number of patients. The craft workshop will thus transform into a modernized factory, leading to exponential growth in productivity. This constitutes the “Industrial Revolution” of the future healthcare industry.

Such changes require several prerequisites: 1. The public gains the capacity for medical decision-making; 2. The philosophical subject-object relationship among doctors, patients, and health conditions evolves; 3. Third-party diagnostic services become widespread, and healthcare institutions undergo a platform-based transformation. The first point has been discussed previously. Regarding the third point, an explosion in third-party diagnostic services is inevitable sooner or later, whereas the platform-based transformation of healthcare institutions will likely require concerted efforts from the government and hospital administrators. Below, we briefly discuss the second point.

In current medical practice across society, there are significant differences in how various parties understand the relationships among healthcare participants. In reality, the relationship between medical institutions, physicians, and patients is one of mutual subjectivity and objectivity. Their respective interests and codes of conduct are inconsistent, often leading to opposition and resulting in numerous conflicts and internal friction. This situation has historical roots. Looking back several decades or even just over ten years, patients generally did not participate in medical decision-making. The primary reasons were the highly specialized nature of medical knowledge and its poor accessibility; patients did not know how to engage and thus voluntarily relinquished all decision-making authority to physicians. During that period, the quality of medical decisions rested entirely with doctors. However, with improved access to information, particularly following the widespread adoption of the internet, the cost of obtaining medical information has decreased significantly, prompting patients to reassert their rights. At this stage, physicians’ inertia toward independent decision-making has not yet dissipated, frequently leading to conflicts between the two parties in medical decision-making and causing internal friction.

In fact, it is reasonable for doctors and patients to participate equally in medical decision-making. However, the power of both parties must be linked to their responsibilities and obligations. Only by clarifying rights and responsibilities can the efficiency and quality of healthcare be ensured. The rights and responsibilities of physicians have already been defined by laws and professional guidelines. So, what are the responsibilities and obligations of patients? Simply put, patients have the obligation to provide truthful information related to diagnosis and treatment (including existing information and information pending verification) and the responsibility to make reasonable judgments regarding treatment plans. Only by fulfilling these responsibilities and obligations can patients legitimately claim their right to participate in medical decision-making. In other words, one of the prerequisites for patients to exercise their decision-making authority is the possession of the capacity to make reasonable judgments, namely, medical decision-making capacity.

This responsibility also clarifies that medical decision-making is not merely medical inquiry. Medical decision-making is a collaborative process in which both parties develop response strategies and solutions based on existing diagnostic information, rather than a one-sided questioning process. Currently, the general public commonly believes that participating in medical decision-making entails relentlessly probing into the diagnostic tests and treatment plans prescribed by physicians, which is unreasonable. While medical inquiry is a patient’s right, it is a right that should be constrained. Under conditions of limited resources, the assertion of this right by some individuals can adversely affect others. In other words, if all patients fully exercised their right to inquire, the existing healthcare system would be unable to bear the burden, leading to disruptions in the decision-making process.

An effective medical decision-making process should involve the patient providing diagnostic information, with the physician supplementing this information as needed and to a sufficient extent, subject to the patient’s consent. The physician then proposes a treatment plan, which is discussed and revised collaboratively by both parties until a final plan is agreed upon. Within this constructive decision-making framework, the relationship between the two parties is characterized by the physician and the patient serving as co-subjects, with the patient’s health status as the object of care. In other words, during the course of disease treatment, the physician and the patient should occupy equally important positions and play equally significant roles.

Standards and Guidelines

The pace at which this new medical relationship takes shape largely depends on how quickly the general public can acquire the capacity for medical decision-making. The key to its success or failure lies in whether diagnostic criteria and treatment guidelines are available for various diseases. Based on extensive scientific research, clinical practice, literature, and expert consensus, these standards and guidelines consolidate the critical points and essentials required for diagnosing and treating a specific disease into a single document. This enables healthcare decision-makers to gain a rapid and focused understanding of the disease’s etiology and pathogenesis, physiological and pathological mechanisms, diagnosis and differential diagnosis, classification and staging, treatment, and prognosis. Much like industrial standards define the nature of production lines, diagnostic and treatment standards and guidelines serve as the prerequisite for scaling and standardizing medical practices. For the general public, learning or comprehending these concise standards and guidelines is far less challenging than grappling with voluminous medical textbooks, while also being more targeted. Similar to an appliance manual that allows first-time users to master basic operations simply by reading it, standards and guidelines act as instruction manuals for managing health. Both physicians and the public can rely on them to address health-related issues.

While standards and guidelines can save the public time and reduce learning costs, selecting the appropriate ones remains a significant challenge for laypeople. For diseases and health conditions lacking established standards or guidelines, individuals must gradually accumulate and learn from vast amounts of fragmented knowledge. Filtering out the most suitable information is even more difficult for the general public. In this context, tools akin to “Meitu Xiuxiu” are needed—applications that can automatically collect, organize, and package relevant knowledge based on individual needs, while also providing optimal solutions, thereby lowering the barrier for the public to acquire medical decision-making capabilities.

Brand-New Tools

The significance and impact of this tool are truly exciting. Just as typewriters replaced most handwriting, USB flash drives replaced briefcases, digital cameras replaced film cameras, and computer programs automated many repetitive manual tasks, the role of next-generation medical software is to help doctors and the public—especially the general public—organize the information needed for medical decision-making in the shortest possible time and determine preliminary courses of action.

Information required for medical decision-making includes past health history, mental status, lifestyle habits, symptoms, signs, and various test results necessary for diagnosis. Among these diagnostic materials, except for the test results, all other information can be provided by the patients themselves and belongs to clinical diagnostic information.

In the current medical model, the completeness of clinical diagnostic information collection primarily depends on the duration of doctor-patient communication, while the quality of information is mainly determined by the physician’s attitude and experience, followed by the patient’s level of cooperation and education. Generally, this portion of information constitutes the first-hand data obtained by physicians, and medical decision-making begins with the analysis of these subjective inputs.

By screening and reasoning through this information within the physician’s knowledge framework, a series of potential hypotheses are generated (which also constitute the outcome of the first round of decision-making). These hypotheses may represent tentative diagnoses or suspicions requiring further verification. If further suspicion remains, the patient is asked to provide additional information. Once subjective information has been fully provided, the next step involves obtaining objective data, most commonly through various diagnostic tests. The newly acquired information is then used to confirm or refute the hypotheses, yielding the results of the next round of decision-making, and this cycle continues iteratively.The medical decision-making process typically terminates in one of three ways: actively by the physician, when the diagnosis is deemed clear or sufficient; actively by the patient, due to doubts about the physician’s decision-making capability; or involuntarily, when all available information has been gathered yet a definitive diagnosis remains elusive. Except in cases where the patient actively terminates the process, treatment plans are generally determined based on the current decision outcomes. These plans may include rest, medication, injections, surgery, and other interventions, along with their specific implementation methods and scheduling, collectively forming the resolution pathway.

In the new healthcare model, the acquisition of clinical diagnostic information can be accomplished by new tools. The collection of such information is highly regular and repetitive, encompassing basic demographic data (e.g., name, gender, age), lifestyle factors (e.g., diet, sleep, urination and defecation patterns), as well as medical history, including past medical history, family genetic history, personal history, and, for female patients, obstetric and gynecological history (menstruation, leukorrhea, pregnancy, and childbirth). Leveraging AI and voice technology, new medical tools can simulate physician-patient interviews to structurally collect this information anytime and anywhere, storing it in the format of outpatient medical records. Patients no longer need to visit hospitals or consult physicians in person; instead, they can complete this process in a relaxed and familiar environment. This approach not only ensures the completeness and quality of data collection but also avoids consuming existing medical resources.

Based on this clinical information, new tools will further provide patients with the medical knowledge they need, which may include articles, educational materials, or diagnostic criteria and guidelines. These tools will also recommend the diagnostic information required for the next round of decision-making, such as complete blood count, urinalysis, X-rays, or advice like “rest for three days.” At this point, equipped with sufficient knowledge, patients can independently determine their next steps—whether to undergo testing at a third-party laboratory, seek care at a hospital, or self-medicate—and make responsible decisions.

When such tools become as ubiquitous as WeChat, the doctor-patient relationship will also undergo a transformation. Leveraging these tools, physicians can manage hundreds of patients per day in a manner akin to solving problems, focusing on monitoring the health status of large populations, identifying suspected critical and severe cases, and providing decision-making recommendations. Meanwhile, patients seeking care at hospitals will also gain the capacity to participate in medical decision-making. This enables doctors and patients to interact on an equal footing in managing health conditions. This represents the future application of medical tools.

The Practice of Traditional Chinese Medicine

Within China’s healthcare system, traditional Chinese medicine (TCM) occupies a highly distinctive position and has consistently played an irreplaceable role. Whether utilized as a primary treatment modality or as a complementary and alternative approach, TCM has become deeply integrated across all levels of the healthcare system.

A major distinction between Traditional Chinese Medicine (TCM) and modern medicine lies in the difficulty of replicating clinical experience. For the same TCM practitioner, two patients with the same disease may receive entirely different diagnoses due to variations in etiology and constitutional predisposition. Similarly, for the same patient, two practitioners operating within different theoretical frameworks may propose vastly different diagnostic and therapeutic approaches. This highly individualized treatment system has constrained the modern development of TCM, particularly in its competition with modern medicine. Even when TCM demonstrates superior therapeutic efficacy, the general public often still prefers modern medical interventions, as their explanations are more readily accepted compared to the esoteric nature of TCM theory. The challenges in standardization and mass applicability have consistently hindered the modern advancement of TCM.

In fact, the clinical decision-making process in Traditional Chinese Medicine (TCM) is quite straightforward: it involves the comprehensive integration of the Four Diagnostic Methods and treatment based on syndrome differentiation. For common diseases, diagnosis relies primarily on inquiry, supplemented by the other three diagnostic methods, to determine the disease and syndrome before prescribing herbal formulas. Compared with modern medicine, which often requires additional tests to confirm a diagnosis, TCM incurs significantly lower diagnostic costs. Therefore, TCM is better positioned to play a significant role in the future healthcare system.
Since Traditional Chinese Medicine (TCM) does not require various diagnostic tests, diagnosis is determined by the physician rather than by data. However, as each TCM practitioner employs different diagnostic criteria, patients must actively choose their provider. Currently, the criteria patients use to select TCM practitioners are rudimentary; relying on common labels such as “senior TCM practitioner” or “renowned doctor” rarely leads to finding a suitable match. This is where the “new tools” discussed in the previous section come into play. Since TCM primarily relies on symptoms for syndrome differentiation, it is straightforward to recommend relevant foundational TCM theories, classical textual references, case studies, and health preservation methods based on a patient’s reported symptoms. TCM theory is not difficult to comprehend, with analogical reasoning being its primary mode of thought. Once patients acquire this knowledge, they need only identify the practitioner they deem most appropriate when making healthcare decisions. Patients can make this judgment by reviewing the symptoms and syndrome patterns a physician specializes in treating, or by evaluating the physician’s responses to their specific condition. This approach grants patients significant autonomy; once a choice is made, the medical decision-making process is effectively complete. For most conditions, prescriptions can even be issued without an in-person consultation. Even when face-to-face visits are necessary, resource matching remains highly feasible, as TCM clinical requirements are minimal—often needing nothing more than a consultation room.

Therefore, traditional Chinese medicine will play a greater role in future healthcare.

Conclusion

Currently, our healthcare system is facing significant challenges. Healthcare reform is proceeding vigorously, and the pressures of demographic shifts are beginning to manifest. The government, market forces, and academia are all striving to find solutions to these challenges. I believe that the answers have long existed in history: the Mass Line principle—"doing everything for the masses, relying on them in everything, from the masses, to the masses"—is exceptionally well-suited to addressing the current situation. Trusting in the public’s capabilities, employing various methods and tools to enhance their medical decision-making competence, returning medical decision-making authority to the public, and valuing the role of Traditional Chinese Medicine may well be the optimal approach to resolving the current predicament and ushering in a new era for healthcare.

This article was submitted to VCBeat by the author, Shan Liang. The views expressed are solely those of the author and do not represent the position of VCBeat.