Simple self-care constitutes the health activities which we do on our own and within familiessuch as brushing our teeth, or going to bed with aspirins during 'flu. Empowered self-care is what can happen when primary, secondary (district general hospital), and tertiary care (eg regional burns units and cancer specialisms) work together with social services within the context of the family life cycle. Crucially, it uses the principles of intermediate care.Of any health care system, ask how rich and deep are its community roots? How many options are there for the care of this sick old lady who has a bad chest and is temporarily off her feet? If your health care system lacks depth, and if ties of religion and family are loose, the only option may be an emergency admission to a high-technology hospital. Emergency admissions in the UK and many other areas have been climbing inexorablyfor many reasons. One important reason is lack of options at the primary care level.
Whenever you think of admitting a patient to hospital, askWhat are the other options? Do this not just to save the hospital work, but to force you to find out what your patient really wants, and to ensure that the most appropriate level of care is found.
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When you think of these options, don't think doctors or nurses?think universal health worker. Universal health workers have various skills: find out about them, and judge them not according to historic professional codes but according to how good they are at empowering self-care. No health service can look after most patients most of the time. Empowered self-care in the context of interdependent social and medical services is not some new option that may or may not be used: it is the only option for health services which aim to look after more than one patient. Without this idea of empowered self-care hospitals become places of passive dependency, they get too full, and you cannot get people in, and you cannot get people out. NB: if you think that empowered self-care is a clich, try doing your diabetic clinic without it: you will always fail.
Empowered self-care entails choice, dialogue, knowledge of mental states informed consent, literacy/education , participation in planning and respect by professionals for lifeworlds other than their own. We have to harmonize our care-plans with the patient's belief system. So if, for example, a man takes strength from meditation, this should feed into the dialogues which inform his empowered self-care. This yields more patient satisfaction and improved outcomes.
Barriers to this type of care
- People who are rendered helpless and hopeless by unemployment, poverty, and family strife. Others who have difficulty accessing care include: the homeless, refugees, drug abusers, ethnic minority groups, and patients living in rural areas without public transport.
- Professionals who want to monopolize and medicalize health.
- Nations which are keener to take up arms than to vaccinate them.
- A world which behaves as if it does not know the meaning of social justice and equality, and in which rich and poor fail to share common objectivesor simply fail to share anything.
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