The Gutenberg Press, one of the most revolutionary inventions in human history rapidly promoted the publication of religious texts—and pornography. The technology itself did not determine the future of the printing press, however; it was the people using it who unleashed its power. One of its most important offspring was the scientific journal, a venue for reliable, peer-reviewed sharing of information that launched the scientific revolution and ushered in the age of technology. Later, a similar ability to disseminate ideas and information across great distances made possible the reshaping of government by the collective efforts of ordinary people and led to one of the most remarkable experiments in human ambition, the U.S. Constitution. The Federalist Papers and the works known as the Anti-Federalist papers, published in the New York press during the ratification process, offer striking examples of the importance for citizen engagement in the political process.
Similarly, establishing common frameworks for discussion have enriched various other sectors of society. The Brandeis Brief refocused argument in the legal profession by establishing a framework for the presentation of facts and discussion. In the corporate world the business plan and the annual report provide readily recognizable formats for evaluating commerce. In the medical context, the medical case presentation, adopted after the Flexner Report, provides a well proven framework to address complex, multi-factorial issues in the face of life and death consequence. As we enter the second decade of the digital revolution, a development likely to eclipse the importance of the Gutenberg Press in importance for human civilization, we need to create a framework for citizen dialogue and communications to harness digital technology for the benefit of mankind and maintain the promise of democracy.
We now live in an era challenged by remarkable advances of digital technology, where social media platforms are connecting billions of individuals across the globe. The immediate consequences for democracy and world stability are mind blowing. In the past year we have witnessed the impact of “fake news,” a savage new form of populism, a tendency for people to declare themselves experts based on a few Google searches, and the globalization of movements. We have seen new technologies challenge the legitimacy of electoral democracy. Rising economic inequality and the superior access of elites to digital platforms have further threatened the democratic order. Technology companies mining clicks of users are developing increasingly sophisticated algorithms that exploit individual biases for political or economic gain.
We are experiencing a political environment where passions have become the main driver of political discourse.
Current technology allows us to rewire the body politic through digital technology. These tools allow unprecedented opportunity to get access to information, mobilize, challenge misinformation provide for a more deliberative dialogue. Digital technology can enhance the effectiveness of government services and provide a way for citizens to be more actively engaged, connected to their political ecosystem. Together with a standardized template, the medical case presentation, offers a way forward for enhanced citizen engagement. Citizenism, our approach to reclaim the role of the citizen in the body politic, builds on this framework and includes a Citizen’s Toolbox to fully actualize their citizen role.
Politicians and interest groups with access to sophisticated digital tools leverage a deep understanding of psychological drives to channel political action by addressing and personalizing messages that promote emotional response and individual action. Information and facts are replaced by opinions and self-serving statistics. The media are fragmented and driven by the need to appeal to factions and interest groups rather than a desire to provide the accountability envisioned by our founding fathers. Rapidly evolving developments in the areas of artificial intelligence and machine learning weaponize digital technology and make seeking a different approach essential. A different framework for digital conversation is needed, a structure that starts with consensus on how to talk about complex issues. As the Brandeis Brief and the business plan refocused discourse in their fields, the Medical Case Presentation, and the accompanying Citizen Brief are uniquely positioned to put the citizen back into "We the People". The Medical Case Presentation represents a framework that summons our fellow citizens to address the challenges confronting us as individuals, as communities and as a nation.
The Medical Case Presentation
The medical case presentation has evolved as an essential framework and structure for a focused and disciplined approach to clearly present, define, and collaborate in addressing medical problems. Healthcare professionals use the medical case presentation to identify, analyze, develop, implement and monitor a solution based “treatment plan.” When used effectively, it allows healthcare professionals to communicate and share information among clinicians and other stakeholders of varied clinical disciplines to develop testable hypotheses for simple and complex problems. The framework allows for clearly identifying pathologies and providing objective data to support the diagnosis and “treatment plan” (including biological, psychological, social and spiritual factors). The medical case presentation is uniquely positioned to address systematic changes over time. Through progress notes addressing specific problems, practitioners are able to adapt to new issues and data to clearly identify problems and potential solutions.
When adapted to the non-medical world, the medical case presentation provides a well-established framework useful in addressing complex and multi-factorial issues that carry life and death consequence. The framework is particularly effective in situations that require intervention in the face of uncertainty. The medical case presentation confronts uncertainty and lays out a plan to achieve the best possible results. The medical case presentation draws people in to objective and non-partisan dialogue built on reliable data, openness, transparency and participation. It supports people in exploring the various elements contributing to a problem in order to generate a situational diagnosis and establish a meaningful treatment plan that is monitored over time. As data associated with the problem change, new information is gathered or new treatments become available, the case is easily updated.
The medical case presentation is a collaborative process consisting of the following general sections:
1. Define the problem to be addressed.
2. Research and provide relevant data needed for rational discussion of the problem.
3. Discuss the various options available, the barriers to action and the consequences of each action or inaction.
4. Formulate an action plan based on measurable outcomes, transparency, accountability and informed consent.
5. Apply the action plan, monitor outcomes and update the action plan.
In the next months we are initiating an experiment to explore the role of a coordinated citizen oriented effort to address a major social-political- economic challenge confronting the US. The effort, the COVID-19 Pandemic Project, utilizes digital technology through blogs, surveys, newsletters and crowdsourcing to provide wide access for many individuals and the democratization of information with real world facts rather than rhetoric to serve as a potent platform to build on the ideas and energy of many to make the process as useful and productive as it can be. The various sections of the COVID-19 case presentation as well as the citizen commission, will be presented over a period of weeks and ongoing discussion will be encouraged. Short and long term goals and plans will be developed and monitored.
The potential of the leveraging of digital technology is inspired by Aaron Swartz, a pioneer in pushing for using digital technology for the common good. Swartz observed that,
“Change doesn’t come from thousands of people, all going their separate ways. Change requires bringing people
together to work on a common goal. That’s hard for technologists to do by themselves. But if they do take that as their goal, they can apply all their talent and ingenuity to the problem. They can measure their success by the number of lives that have been improved by the changes they fought for, rather than the number of people who have visited their website. They can learn which technologies actually make a difference and which ones are merely indulgences. And they can iterate, improve, and scale.”