There’s a better way for us to ‘get our needs met’. Can we talk about it?

Benjamin P. Taylor
3 min readFeb 13, 2024

Join the discussion on LinkedIn:

Two weeks ago, I posted on the ‘royal paradigm’ that underpins visits to a doctor in the UK.

Given the broken state of our healthcare system, I should have realised that lots of people would respond by:

- sharing my assumed frustration and complaint about the system and the way ‘doctors’ (general practitioners) work

- defending the incredibly tough, overstretched, overworked, committed work doctors do

Last week, a participant in one of our Commissioning Academies asked for a reminder about what word a speaker ‘had used instead of needs’.

And this week, Cormac Russell posted on Twitter about the ‘four models’ he uses to illustrate a progression:

- To= everything done, is to us & without us. (Medical Model)

- For= everything done, is done for us; without us. (Charity Model)

- With= nothing for us without us. (Social Model/Coproduction/Co-design, Asset-based approaches)

- By= done by us for us. (Asset-based Community Development)

Link to that Twitter conversation:

This drew some really interesting responses defending ‘the medical model’ and medical practice.

It’s really hard to talk about a radically different way of thinking about people getting what they need in their lives without misunderstanding, defensiveness, and justifiable pushback from people who see mistaken critique of vitally important and very hard work they do or support.


Three points:


We talk — often too glibly — about ‘paradigm shifts’.But this is like that. To find a word that replaces ‘needs’ but allows the same system of a Poor Sick Miserable Person coming to a System, being Assessed and receiving a Service based on their Needs… doesn’t work.

Talk instead of people’s purpose in life, how they sometimes can’t achieve their intent on their own, and they need to engage with other people to achieve it. They — and their desires, and their capability — are then ‘central’, but also interdependent on others.


The imbalance of power in the broken worldview we inhabit disables us all — the Provider and the Client, the overworked professional and the agitator.

AND there are *always* people connecting as humans, working across power dynamics, being real, getting the job done, getting as much out as they give, despite ‘the system’.


If we want to try to achieve this kind of change, we have to work hard at our communications. It’s tempting, rewarding, and the path of least resistance, to be ‘in opposition’ to ‘the oppressive system’. It’s even assumed when you don’t mean it!

So — as in the conversations above — we all have to engage and work things through, try to communicate a different way while we’re all inside the current model.

There are so many ways to do it wrong, and to communicate wrong.


the end result might *seem* very similar

If you break a bone you will need urgent medical assistance. Obtaining that in a system where we are all humans, all citizens, might be very similar and very different.


What problems do you have with what I’ve said?

What makes you think ‘ah, there is another way’?

Also my bit about doctors — ‘prescriptive power’ — actually meant to illustrate that despite this entire power imbalance, the success of healing and happiness and all the things we try to ‘help’ people with always lies with the people themselves!