We often hear the phrase “practice what you preach.” As both a physician and a patient, I’ve learned that nowhere is this more important than in how we navigate health care.

Over the years, I’ve written about the importance of collaboration between physicians and patients. But as I’ve grown older and more frequently interact with the health care system, I’ve come to believe that good care rests on four essential elements:

• Agency
• Advocacy
• Responsibility
• Partnership

Each of these plays a distinct role in the care journey. But when working in balance, they empower better communication, better outcomes, and better experiences for everyone involved.

Health care isn’t a transaction, and it’s beyond a relationship. It’s a partnership.

There’s a lingering myth that health care is something done to us, not with us. You see a doctor, describe symptoms, get a diagnosis, and follow instructions.

That model is outdated and often leads to missed details, disengagement, or avoidable harm.

The truth is, health care is most effective when it becomes a partnership. One where:

• Physicians bring their clinical knowledge, experience, and compassion
• Patients bring their questions, values, lived experience, and engagement

That’s the 50-50 model I advocate for. Not a 90-10 or 70-30, but an equal partnership.

What is patient agency?

Agency refers to your ability to make informed choices, ask questions, and participate actively in your care.

This includes:

• Understanding your diagnosis and treatment options
• Asking “what if,” “why,” and “what happens if I don’t”
• Voicing concerns, and being sure that you are heard
• Making decisions that align with your values

Agency is not about mistrusting doctors—it’s about engaging with them. It means co-owning the process of healing.

Responsibility: Following through

Agency without follow-through is like having a roadmap and never taking the trip.

Responsibility means:

• Showing up for appointments
• Following the treatment plan that includes completing tests and labs and taking medications as prescribed
• Noticing and reporting changes in symptoms
• Following up when the system doesn’t

Even the best care plans don’t work if they aren’t acted upon. Being a responsible patient ensures that the partnership stays intact even when the system fails to do its part.

A real-life example: When the system went silent

Three years ago, I had a routine colonoscopy—one that unexpectedly revealed a large pre-malignant lesion in the cecum, the farthest point the scope typically reaches.

The first physician wasn’t comfortable removing it, and I was appropriately referred to a more advanced specialist. Fortunately and thankfully, the lesion was removed without the need for what would have been extensive colon surgery.

A follow-up colonoscopy three months later was clean, and I was told to return in three years.

And then … nothing.

No call. No reminder. No appointment.

It would’ve been easy to ignore it. But I knew better.

Self-advocacy in action

I called the GI office:

• Week 1: “We’ll call you back.”
• Week 2: Silence.
• Week 3: Still no appointment. Eventually, I was told to find a new gastroenterologist—my original physician had retired.

Meanwhile, I began experiencing new symptoms: fatigue and a new onset of shortness of breath. While due for routine lipid and liver function tests (I take statins), I asked my cardiologist to include a CBC, recalling a past GI bleed with similar signs save for the shortness of breath.

That CBC showed a significant anemia which was later confirmed as due to iron deficiency. When I finally got the colonoscopy, a bleeding site was found and cauterized, so this identified the source of the anemia, but still didn’t necessarily resolve the shortness of breath issue in my mind, nor that of my primary care physician.

If I hadn’t spoken up, followed through, or requested that CBC, the outcome could have been very different.

Enter: the advocate

But what if I hadn’t been a physician? What if I hadn’t had the confidence or knowledge to keep pushing?

This is where the role of a patient advocate becomes essential.

Patient advocates can:

• Speak on your behalf when you can’t
• Navigate referrals, records, red tape, and reconcile complex and confusing billing issues
• Clarify complex information
• Flag red flags when your health care professional may miss them
• Ensure that agency doesn’t disappear in the face of illness, age, or overwhelm

An advocate can be a family member, friend, or a trained professional. Regardless of who it is, their role is to make sure that the patient’s voice is never lost.

Partnership: the heart of the matter

While agency, advocacy, and responsibility are vital, they all function best within the container of partnership.

The physician–patient partnership is not just a nice ideal—it’s the engine of effective care.

It’s built on:

• Mutual respect
• Open dialogue
• Accountability and responsibility on both sides
• Trust that flows in both directions

Doctors do better when patients are involved. Patients do better when they feel heard, understood, and supported.

This partnership, like any meaningful relationship, requires both sides to show up.

Lessons learned

My story had a positive outcome. But it could have ended differently. And I know firsthand that not every patient can advocate for themselves. That’s why we must support all four pillars:

• Agency empowers patients
• Responsibility ensures follow-through
• Advocacy protects the vulnerable
• Partnership binds all of it together

When one part is missing, the system wobbles. When all four are present, care becomes humane, effective, and personal.

So I’ll ask you:

Are you taking an active role in your care? Do you have someone who can advocate for you if you can’t? Are you treating your relationship with your physician as a partnership or a transaction? Are you, as a provider, creating space for patient voices and advocate participation?

Alan P. Feren is a retired surgeon, independent physician, health care consultant, and patient advocate with more than 50 years of experience in clinical practice, system leadership, and health care innovation. Formerly in academic and community surgical practice, he has worked across the evolving landscape of managed care and clinical governance.

In the 1990s, Dr. Feren co-authored clinical guidelines that evolved into what is now MCG Health, now used by more than 80 percent of U.S. health plans and over 3,100 hospitals. He has advised health technology startups, helped shape managed care policy, and served as a clinical content developer for health care technology platforms.

His work centers on restoring shared understanding between clinicians and patients in an era defined by speed, fragmentation, and technological mediation. Drawing on both professional experience and his own journey as a complex patient, he writes about transparency, accountability, and the disciplined methods that make medical care trustworthy. He is a contributor to KevinMD and a podcast guest. More information is available at mypersonaladvocate.net and on LinkedIn.