There have been great strides made in designing the administrative structures of patient-centered care, but it is still difficult to design truly patient-centered clinical routines that the entire healthcare team can enact.  The kind of partnership, in which patients are fully part of the team that guides their own care, goes against so much of the training and socialization of health professionals and, for that matter, the expectations of many patients.  This is particularly true for patients we sometimes call  complex.  In other contexts, we call them  high utilizers,   disadvantaged,   heartsink patients,  or  people with trauma histories.   Blount calls them  multiply-disadvantaged  patients.