Laypeople as Providers of Health Care

Say the words “health care” and most of us see visions of surgical suites and CAT scanners, hospitals and doctors’ offices. The Marcus Welby model of medicine so dominates our thinking that it is quite a shock to discover what a tiny proportion of symptoms are ever seen by health professionals.

The diagram shows the result of one British study in which people were asked what they had done about recent health problems they considered worrisome. The researchers found that subjects had dealt with 79 percent of all problems entirely on their own. When subjects consulted a physician they usually did so only after attempting self-treatment.(1)

A more recent U.S. study asked 1,200 healthy adults how many health problems of any kind they had experienced in the previous two weeks. The researchers concluded that the average North American experiences a staggering 117 health problems per year.(2)

Since the typical North American makes only one or two doctor visits per year, this study implies that we serve as our own doctors roughly 99 percent of the time. If only one percent of the people who presently use self-care decided to visit a doctor instead, there would be a 100 percent increase in the number of doctors’ visits. These figures lead to the inescapable conclusion that virtually all health care is self-care.

Exactly how do we take care of ourselves?

The table shows the choices we make when we manage our own illnesses:(3)

No treatment	41%
Home remedy	15%
Prescription drug already present in the home	12%
Over-the-counter medication	38%

In one of the most interesting studies of self-care, English medical student Christopher Elliott-Binns sat in a general practitioner’s office and interviewed 1,000 patients who came in with new problems. He asked if they had sought information and advice about their problem, or used self-care before coming to see the doctor.
Ninety-six percent answered yes to one or both questions. Eighty-eight percent said they had received advice and 52 percent had used at least one form of self-treatment. In addition, 16 percent had sought information in books, magazines, or other media. The subjects frequently received advice from multiple sources. One patient, a boy with acne, had gotten advice from 11 different sources.

In the opinion of a panel of physicians, the advice the subjects received from friends and family members was quite sound. The best advice of all came from pharmacists, nurses, and relatives. Among family members, wives provided the best advice.

What People Do About Their Symptoms

Not Seen by Professional	79%
Did Nothing	16%
Self Care Only	63%
Seen By Professional	21%
Self-Care Plus Doctor Visit	12%
Doctor Visit Only	8%
Directly to Hospital	1%

Elliott-Binns concluded:

“It is most interesting that 96 percent of patients had received advice or treatment before coming to the physician. Is it justifiable to call the family doctor the source of primary care?”(4)

Clearly it is not. As this study makes dramatically clear, the real primary care is self-care.

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