Four major trends fuel the growth of self-responsibility for health.
Trend One: The Shift from Professional Care to Self-Care. In medicine as in other economic areas, laypeople are now doing an end run around professionals, using new institutions, new technologies, and new methods of communication to deal with problems directly rather than relying on professionals. This shift is occurring in other economic sectors as well.
Ten years ago, if you had a sum of money to invest, you probably put it in the bank. The bank would invest your money pay you a fixed rate of interest, and pocket the difference. Today we are much more likely to invest that money ourselves—in a money market account, a mutual fund, a certificate of deposit, or elsewhere. We have realized that bankers do not have a monopoly on investing.
In the same way, we have realized that doctors do not have a monopoly on health. Under the old system consumers were encouraged to believe that doctors could “fix” virtually any health problem. Under the new self-care oriented system, we know that there is frequently little the doctor can do, but that if we take reasonably good care of ourselves, we will rarely need health professionals. It is an irony of medical history that as the result of the current medical malpractice crisis, the American Medical Association is now waging a public relations campaign to convince consumers not to expect too much of physicians.1
Trend Two: From “One Ill, One Pill” to Multiple Options. A decade or two ago, most things were done in a pretty standard way. When there was a choice, it was usually of the either/or variety: Dad went to work. Mom stayed home and had 2.4 kids. You either got married or you didn’t. You drove a Ford or a Chevy. When you ordered ice cream, you could choose from either vanilla or chocolate. All bathtubs were white. All telephones were black. That was the way it was.
It was much the same in health care. You went to the doctor, gave a history, and described your symptoms. The doctor would ask some questions, thump you a time or two, perhaps order a few lab tests. Then out came the little white pad and you received a prescription.
That’s not the way it works any more. Consumers can now choose between multiple options—John Naisbitt, author of the book Megatrends, calls this today’s “Baskin-Robbins society.” Today, everything comes in at least 31 flavors. The new car buyer can choose from among more than 750 different models. There’s a store in New York that sells 2,500 different types of light bulbs. You can currently choose among several dozen herb teas.
Health care offers more choices as well. Most conditions can be treated in a number of ways. If medical treatment is called for, there are frequently a variety of alternative drugs and dosages. The same is true if the choice is between alternative remedies. Consumers now expect to consider their alternatives and to chose the one that seems best. This may mean choosing among several drugs, or choosing no drug at all. It may mean visiting another doctor, seeking a second opinion, or seeking advice from any one of a growing number of alternative practitioners. Or it may mean using exercise, nutrition, relaxation, visualization, psychological approaches or other non-specific pro-health measures to help deal with the problem.
If there is a downside to self-care, it is that it requires a good deal more effort to do it yourself. Despite the changes described above, many people still prefer to be told what to do.
Trend Three: The Home as Health Center. According to home health care industry sources. roughly 25 to 30 percent of patients now in hospitals don’t really need to be there. They could be cared for just as safely and much more economically at home. Millions of patients have already avoided needless hospitalization, making home health care the most rapidly growing part of the health care system.2
This rapid growth is partly the result of new at-home versions of tools previously available only in the hospital (kidney dialysis equipment, intravenous nutrition. and cancer chemotherapy), the explosive growth of at-home medical testing, (blood pressure, blood sugar, portable EKG monitors) and the emergence of health professionals who work principally in patients’ homes.
New at-home devices (exercise machines, exercise videos, relaxation tapes, pulse meters, home whirlpool baths, stationary swimming devices, and computer-based nutrition support systems) now make it possible for the health-active individual to do things at home that were formerly available only at a well-equipped health club.
Trend Four: Health Care as Information Flow. In some ways, the health information explosion has been the most dramatic of all. In 1977, self-care books accounted for only three percent of total nonfiction bestseller hardcover sales. Only four years later the proportion had increased to 23 percent. Self-care bestsellers showed a 1200 percent increase in sales during this period.
Health coverage in periodicals has showed a similar growth. Circulations of health magazines more than doubled between 1970 and 1980.3 There has been an explosion of health information in general publications as well. Three of the nation’s most widely-read weekly publications—Time, Newsweek, and the Sunday New York Times—have recently instituted special health sections or editions. The future promises electronic access to elaborate new health databanks through home computers.
Self-Care and The Future of Health. But a continuing trend toward self responsibility is not enough to insure the full flowering of a health care system built around the individual and the family. If the four legs of health care are indeed tools, skills, information, and support, and if, as it seems, the tools and the information available to generations to come will outstrip the imaginations of even the most wild-eyed self-care advocates, then the two most important potential barriers to the development of self-care would be the lack of individual health skills and the lack of professional and social support for self-care.
Thus we are left with two pressing issues of public policy:
- Health literacy—The health education currently offered in our schools does little to equip our children to deal with today’s health realities—let alone the future’s. I believe it will take a commitment to health literacy comparable to this nation’s earlier commitment to literacy in English to prepare our children to use these new medical devices and to understand the broad range of health information available to them.
- Professional support for self-care— Students aspiring to the health professions should be selected for their aptitude to encourage self-responsibility and to support responsible self-care. All clinicians should be competent in the skills of communication, negotiation, and interpersonal relations. Clinicians in practice should be evaluated regularly by the consumers they serve, and these evaluations should be given considerable weight in determining salary and advancement.
1 Brinkley, Joel, “Physicians Have an Image Problem—It’s Too Good, ” The New York Times, Feb. 10, 1985,p.6E.
2 Ferguson, Tom, “The Homecare Revolution, “Medical Self-Care, Spring, 1985, No. 25, Pp. 25-30.
3 John Fiorello, Editor, Helping Ourselves to Health: The Self-Care and Personal Health Enhancement Market in the U.S., New York, 1983, The Health Strategy Group, 325 Spring Street, New York NY 10013, p.40.