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Ralph Nader > In the Public Interest > Help the Doctor Help You

Here comes the “activated pa­tient” — the latest erosion of what some call “mediococentricity,” or the monopoly over health care by the physician.

Although many doctors now recog­nize the value of having nurse practi­tioners and physicians’ assistants handle some routine medial proce­dures, only a few are heralding health education programs centering on the self-care idea. What is self-care? is it the old, common sense wisdom of taking care of your health? Is it a way to help your physician help you? Is it a proc­ess designed to reduce the need for clinic and hospital care? Is it a meth­od of reducing the dollar amounts you pay to the providers of medical care?

It’s all of these and yet, some­thing more. Just how much more de­pends on the viewpoint of the physi­cians who run the approximately 15 self-care programs now underway in the

Generally, according to a recent government-sponsored Arthur D. Lit­tle report, “patient activation” means enhancing “patient involve­ment n personal health care though teaching of self-care skills (physical) and principles of prevention.”

At Georgetown University’s Center for Continuing Health Education in Washington, D.C., the activated pa­tient program includes instruction in such areas as:

Prevention of arteriosclerosis, cir­rhosis, uterine cancer and heart dis­ease; compliance with medical regimens; hypertention; nutrition; common childhood illnesses; first aid; alcoholism; mental health and family relations, and automation and innovation in health care.

The Georgetown course does more than alert consumers to check­lists of causes and warning signs; it instructs on how to perform proce­dures for oneself such as self-admin­istered blood pressure and ear wax irrigation.

In a sense, the activated patient concept has long been operating in the self-management of health prob­lems. As Dr. Robert F. Rushmer writes in his book, “Humanizing Health Care: Alternative Futures for Medicine:”

“Diabetics are taught to inject their own insulin and to regulate their dosages and diets to maintain themselves in balance. This is large­ly an individual effort under the direction of physicians.”

Obviously, the controversy over self-care heightens in two areas. One is where the consumer is taught how to conduct certain medical proce­dures.

Taking a throat culture or doing an ear examination with an otoscope on one’s child are two examples. Drs. Donald Vickery and James F. Fries, authors of the forthcoming book. “Take Care of Yourself, the Consum­er’s Guide to Medical Care,” consid­er otoscope use by consumers as going too far.

Second, showing consumers how to save money when purchasing drugs, health insurance or medical services is also controversial. Many physi­cians disliked questioning by patients about the quality or cost of their health care. A doctor once told me that for patients “ignorance is bliss” and “trust is everything.”