Now, Do-It-Yourself Care
By: Source: AARP Bulletin Today Date Posted: 2003-08-05 14:50:10
When it comes to anthrax, some Americans aren't relying on others to protect their health. Instead, they're bypassing doctors and buying the antibiotic Cipro on the Web—just in case.
Stockpiling Cipro with neither a prescription nor professional medical advice is just one indication of how Americans increasingly take their health care into their own hands.
It's a controversial trend that began well before the recent bioterrorist attacks and one that's likely to grow as baby boomers—who are used to being in charge of everything, including their health—grow older.
"I think we're going to see more and more self-care; the baby boomer generation is going to demand it," says Kathleen A. Cameron, head of the American Society of Consultant Pharmacists' foundation.
Of 1,500 adults over age 18 surveyed in 2001 by the research group Roper Starch Worldwide for the Consumer Healthcare Products Association (CHPA), nearly three-fourths—including 54 percent of those age 65 or over—said they prefer treating health problems themselves. And 48 percent of older respondents said they're more likely than they were a year earlier to self-treat.
CHPA surveys over the last two decades have seen an upswing in the percentage of consumers managing their own care. "Self-reliance is a dominant theme of American lifestyles in this millennium," says Michael Maves, M.D., CHPA president who is the new CEO of the American Medical Association (AMA).
Coleen and Jim Mister of Pocomoke City, Md., are among the self-reliant, tending to minor medical problems themselves. "We have a fine family doctor, but we hate to make an appointment if it's something we can treat ourselves," says Coleen Mister, 67, a retired educator. She used an elastic brace from the drug store to treat a recent bout of tendinitis in her elbow. Her husband Jim, 71, a former aerospace mechanical draftsman, takes over-the-counter medicine for his sinus headaches.
Most health experts see pluses and minuses to self-care. On the upside, they say, people are taking more responsibility for their health and getting their care in more practical ways.
Such individuals don't stop going to their doctors, says health researcher Holly Heline of Roper Starch. But they do use them differently, going to them only for serious problems.
Maves says American consumers are smart enough to know that "self-care is convenient and efficient regardless of your age." He adds that they're also smart enough to know when to consult a doctor.
Not all experts are so sure. Consumers may not know if a treatment they're using is inappropriate or even dangerous. Or they may mistake serious symptoms for minor ones, delaying needed medical attention.
The underlying cause of a physical complaint "could be trivial or it could be serious," says Thomas R. Reardon, M.D., former AMA president and a general practitioner in Portland, Ore. Patients need to see a physician to find out.
Some treatments that seem benign, such as Cipro, may in fact carry risks. "All antibiotics have side effects," warns AMA Chairman Timothy T. Flaherty, M.D., "and it's risky for people to take antibiotics when they don't really have an infection."
Taken for long periods, Cipro and other antibiotics can overwhelm "good" bacteria that protect the body. And overusing them can cause bacteria to become resistant to them.
Self-treatment can go awry in many ways. A man with early-stage prostate cancer, for instance, found unproven treatments like shark cartilage on the Internet and didn't see a cancer specialist until his disease had advanced.
In another case, a woman who believed she was too healthy to have a heart attack took antacids for what seemed to be indigestion. When the pain worsened, she finally went to the hospital—and had emergency bypass surgery.
Such reports aside, many Americans seem determined to stay out of the doctor's office.
Some factors behind the trend:
- Rising prescription drug prices and the high cost of medical exams and procedures.
- The growing number of effective, affordable medicines sold over the counter.
- The array of home diagnostic tests for everything from cholesterol and cancer to diabetes and HIV.
- The continuing love affair with herbal and dietary supplements. Roper Starch reports 57 percent of older adults use them.
- The vast amount of health information available on the Web and elsewhere. Older Americans — the fastest-growing online group — " are flocking to the Internet, " says Roger W. Morrell, research director at GeroTech, a Reston, Va., firm that designs websites for older adults.
- Increasing dissatisfaction with overbooked doctors' offices and a bureaucratic medical system that doesn't always deliver high-quality care.
No one regrets such inadequacies more than doctors themselves. "I am sorry that the medical system is so inhospitable that people feel they have to turn to self-care," says Marcia Angell, M.D., former editor of the New England Journal of Medicine who teaches at Harvard Medical School.
But, she tells the AARP Bulletin, "technical judgments should not be made by patients, they should be made by doctors." For example, can a patient tell a simple sore throat apart from a streptococcus infection? "If it's strep," she says, "you need an antibiotic, not a throat lozenge."
Angell and others say that trust in one's primary doctor is crucial to good care and better collaboration between patient and doctor. "We need to have more shared decision making in medical care," says John M. Eisenberg, M.D., director of the federal Agency for Healthcare Research and Quality. But we don't need to go "from doctors making all the decisions to patients making all the decisions."
Not to worry, says Maves. "Consumers understand when to go to their doctor and when to rely on themselves." They know, he adds, "there's really no substitute for your doctor's professional opinion."
Peggy Eastman is a Washington-based freelance writer.
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