Self management: Helping a person become their own healthcare expert

and how we can help

Health care in many places hasn’t moved an awful lot from a ‘patch ’em up and send ’em out’ mentality.  This is a great approach if you’re basically healthy, have acute appendicitis, and a quick recovery.  It’s not so good if you have chronic pain, are having to learn to live with it, and find your general coping is compromised.

Most of our health care training, however, is designed to follow the medical model (despite arguments that occupational therapists, for example, are trained in a biopsychosocial model – just watch what happens when a referral for therapy is received without a diagnosis!).  There is nothing fundamentally wrong with the medical model when it’s being used in the right place – it’s simply inadequate when the health problem can’t be ‘fixed’.  And the problem with our health care training is that it’s focused primarily on ‘diagnosing’ deficits, patching them up (or compensating for them) and hoping the person will get on with it.

How else can it be done?  There are a couple of models that we can use – the biopsychosocial model, the motivational interviewing ‘spirit’, and the strengths-based models spring to mind.

We also need to remember that not every person we see is quite ready to become their own healthcare expert. There is probably a point at which the person needs to be introduced to the idea, especially with an acquired health problem like chronic pain,  that only they can really know what does and doesn’t suit them for their health management.  Dealing with resistance to the move from being advised what to do to deciding what to do is also part of the process.

How can we help?

Firstly we can recognise the work of managing an ongoing health condition:

There is direct illness related work
– Identifying providers, going to appointments, the medication regimen, the treatment regimen, the rehabilitation program

There is indirect illness related work
– Insurance claims, funding issues, transportation, advocacy and communication, researching treatment options

There is the personal work of
– reconstructing self identity
– accommodating to change

And finally there is everyday life work
– Additional time required for ADLs, developing work/school options, keeping up, covering up, pacing – oh and fun!

We need to recognize who the health care workers really are – patients and their families.  We need to acknowledge, train and support them. We especially need to recognize individual’s strengths and resilience.

Self management is both a philosophy and a tool – it recognizes patients and families must be active managers of their health care (so they may not ‘do as they’re told!’).  We as clinicians need to see that individuals bring strengths and resource to their consultations.  Self management asks us to play a different role – we need to be teachers and consultants.  It also recognizes individuals may have different goals and that health enhancement, or getting on with the business of life is as important as symptom relief.

Four main ingredients in self management:

  • Knowledge of the condition and health care resources
  • Problem solving ability or training
  • Skill acquisition
  • Self-monitoring

What roles can you play in helping people develop skill and confidence in these areas?

What makes people effective at self management?

  • Recognize that health is your responsibility – your life, your health, your choice, your outcomes
  • Get education & training
  • Set short and long term goals within your health care problem and in the rest of your life
  • Recognize strengths and abilities
  • Develop a support system
  • Advocate for self and others – be effective at communicating (both listening and expressing)
  • Have a purpose beyond ‘managing the symptoms’

So, what roles can you play in helping people develop skill and confidence in these areas?

We can help people become their own healthcare experts by suggesting:

  1. Prepare for health visits, know what you want, get routine tests ahead of time so visits can devoted to discussing results
  2. Focus on key issues, write out questions in advance
  3. Develop a plan for your health – know when you need tests, reviews and support
  4. Develop a team and a system for records–timeline, providers, symptoms, medications
  5. Teach your healthcare team about how to your supporters

What do we as clinicians need to do?

  1. Respect the work done by persons with chronic conditions
  2. Acknowledge patients and families as team members and leaders
  3. Recognize individual’s strengths and resources
  4. Structure a consultative relationship
  5. Focus on the goals of patients and families
  6. Adopt a health enhancement model of care
  7. Provide opportunity for training/education
  8. Remember that this person may be one of many patients, but it is this person’s only life

Much of this post is abridged from a presentation by Stephen T. Wegener, PhD Department of Physical Medicine and Rehabilitation Johns Hopkins School of Medicine, 2004.

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  1. ‘Self Help Health Care’ is a discipline I have chosen, to develop the concept that health care begins at home, long before an individual sees a specialist with a health problem. With the right tools any induvidual can become an expert in managing their health.
    I believe health promotion and disease prevention strategies have been taking a secondary place in health care systems. This is a new project in its early stage, once accepted any one can become an expert in their health.

    This post is informative. The self management aspect is similar to my self help concept.

  2. Hi Kathy
    Thanks for commenting. Yes I agree that self help health care is so much more than responding to ill health, it’s about being well in all aspects of life. Thank goodness for doctors and others when you have ill health (especially a broken bone!), but in the main it’s about living well.

  3. This is a wonderful post. It captures the challenges faced by individuals with chronic health problems.

    The early recovery period is often a full-time job. At times, it seems as if little progress is being made and/or there are two steps back for every step forward. Thus the importance of setting observable and measurable goals. It lends an objective reality check to the subjective experience.

    I would like to add that environmental change is often needed if one is to maintain changes in behavior. A change in lifestyle is easier said then done.

  4. Thanks Neal, I think recovery involves a whole raft of different activities, and life is never ‘the same’, it will evolve into something new and different. Change isn’t easy, and people need to be informed and learn about how to self manage.

  5. Hi Tami
    No, there isn’t. I picked up a pdf of the lecture somewhere on the interweb, but there isn’t very much info on it: these are his details on the paper itself Stephen T. Wegener, PhD, Department of Physical Medicine and Rehabilitation
    Johns Hopkins School of Medicine
    I hope this helps!

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