Asking Doctors Tough Questions

In previous posts I mentioned the issue of getting doctors to wash their hands, and how hospitals are trying to do that - from an initiative to get patients to ask their doctor, to getting nurses to remind them.  So I was quite interested to see this new article from the Wall St. Journal:  Finding a Way to Ask Doctors Tough Questions .

For me it raises the question "Whose responsibility is it to get the Doctor to Wash his hands?"  The organization's or the patient's?  If the organization fails to make this happen, then it seems to fall on the patient.  Is that how it should be?  Is that even the right question?  Or, should we consider this a brilliant solution:  the distribution of responsibility to clinicians and patients?
This article points to the need for patients to advocate for themselves, which includes requesting medication and asking pre-surgery questions.  Some hospitals have patient advocates, which is a great way to address this issue, because in medical situations where when we feel vulnerable it's hard to speak up.  So one side of the solution is advocacy - speaking up for ourselves or getting advocates to speak up for us. 
I'm still wondering about the need for the hospital staff to take on these issues, of improving the way they deliver care.  I'm fairly sure it's a both/and situation (not either/or) - hospitals need to try to get the clinicians to change their behavior, at the same time that patients need to advocate for themselves.

What about disparity in health care delivery?  I noted with interest this sentence from the article: "The Robert Wood Johnson Foundation's ... is providing $300 million in grants for community programs designed to get consumers to take an active role in their own care, especially those from certain racial and ethnic backgrounds."

Does this both/and approach mean that the solution rests with the racial and ethnic groups who need to be more vocal, because the research shows that they don’t get the same quality of health care as white, mainstream Americans?  Doesn’t the bulk of the responsibility lie with the health care industry to improve their delivery of service, in re. disparity?  Having worked on a project to reduce disparities in treatment and prevention of tobacco use, I can see the need to focus on the operational side, on delivery of services.  Hopefully there will be more funding put into addressing disparities, which has already begun to happen.

Thanks to Janet Britcher for forwarding the article :)