The modern doctor evokes respect and awe, mixed with some fear and suspicion. At the most basic level a power relationship starts to exist as soon as we feel that another person holds in their hands an important key to our own life, death or happiness. We feel that we need them and this gives them power. However modern medicine reinforces this age-old pattern of dependency further because of the enormous progress made by modern medical science; progress which is underpinned by an interlocking system of research, education, accreditation, power and money. So, to put this another way, for thousands of years doctors have had power over patients; but since the development of modern medicine in this power has grown considerably – because modern medicine really works.

Ultimately Personal Health Budgets cannot be understood without thinking about this relationship, because it is an innovation within the doctor-patient relationship. It is not an innovation that effects everything in medicine directly; for there are many areas of modern medicine where the use of Personal Health Budgets would be entirely inappropriate. However it does create the possibility of a new kind of partnership between doctors and patients – at certain points – and as such this does start to change the whole relationship.