Microdemocracy: A new starting point for shared decision-making and democratic action

Each year, Medicaid-insured patients have over fifty million encounters with healthcare services. Those encounters frequently do not include the active participation of patients in shared decision-making and they also are the endpoints of their engagement with the public sector. Those same encounters could, however, become new starting points for both improving health care outcomes and increasing participation in democracy. We will share lessons about the challenges patients face when they do not know how to ask their own questions or focus effectively on decisions. This prevents participation in health care and in democracy. Our research and experience in many fields and communities details how to build new capacity for action by deliberately teaching patients the skills to focus effectively on decisions and ask their own questions. We will share lessons from how patients in low-income communities can learn the skills as part of their on-going relationships with community health workers, frontline staff and healthcare providers. Their actions, once they put the skills into practice, illustrate a new concept that we call Microdemocracy. We will present the evolution of- the idea of Microdemocracy, an argument that individual encounters with health care providers can become opportunities to learn both essential health advocacy skills and essential democratic skills. In each of these settings, as patients learn to participate in decisions, they are also demonstrating the habits and practices of a citizen in a democracy. We will examine the democratic implications of experiences at the “micro” level of health care institutions.