Is there a change in the size of a mole that needs to be checked for a melanoma? Is a compressive feeling in the chest signalling an attack of angina or even a heart attack? ... Early detection of symptoms and signs, followed by self-referral to a competent care provider, can help prevent many complications.
The centenary of the discovery of insulin, by a Nobel Prize-winning team of scientists at the University of Toronto, will be celebrated in 2022. Insulin has been used by millions of people with diabetes since then as a life-saving medicine. An eminent Indian endocrinologist says that ‘self care’ is the most important innovation in the management of diabetes since the discovery of insulin. This applies not only to self-administration of insulin but also the use of testing strips for detection of glucose in urine or blood. It also involves adherence to other medicines, detection and management of hypoglycemia (low blood sugar) and care of feet to avoid diabetic foot ulcers.
The WHO defines ‘self care’ as “the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a healthcare provider”. It is remarkable that the definition is not restricted to individuals but includes support from other laypersons. It also recognises the value of self care even when a healthcare provider is involved.
For self care to be effective, a person should be able to acquire needed competencies and confidence. (S)he should be able to say “I know” (knowledge), “I wish to” (motivation) and “I can” (skills). Since external barriers can exist, they also need to feel “It is possible” (no obstacles to practise what I wish to) and “I will find support when needed” (systems, teams and individuals are available to help). These principles apply at individual, family and community levels. Even when a healthcare provider is engaged, management should involve participatory decision-making rather than a paternalistic prescription driven by information asymmetry.
Self care extends across all aspects of health—from promotion and protection of good health to the prevention, diagnosis, treatment, rehabilitation and palliation of disease and its effects on the body. Adoption of good personal habits (hygiene, sleep, diet, adequate physical activity, yoga, meditation), avoidance of harmful behaviours (consumption of tobacco products, alcohol, ultra-processed foods), use of protective methods (seat belts, helmets, masks, vaccines, safe sex) are all part of self care.
Diagnosing one’s illness or a potential risk factor is also part of self care. Is there a breast lump, detected on self-examination, that needs evaluation? Is there a change of bowel habits that calls for investigation of colon cancer? Is there a change in the size of a mole that needs to be checked for a melanoma? Is chest pain or a compressive feeling in the chest signalling an attack of angina or even a heart attack? What are the symptoms and signs of a brain stroke that warrant the seeking of urgent medical attention? Early detection of symptoms and signs, followed by self-referral to a competent care provider, can prevent many complications.
Often treatment can be initiated or continued by a person as part of self care. Chewing and swallowing a tablet of soluble aspirin, when chest pain suggests a developing heart attack, can restore blood supply by disintegrating the clot that is blocking it in the coronary artery. This can be initiated even before rushing to the hospital emergency. Persons with diabetes become adept at injecting themselves with insulin. Adherence to prescribed medicines is important, as is awareness of side effects that may be mild or adverse reactions that may be serious. It is important to recognise spurious medicines and unproven claims of efficacy. Physical rehabilitation after illness or injury requires adherence to diet, exercises or speech therapy.
It is also important to know the rights of patients. While litigation is ideally avoided, human as well as consumer rights may need to be asserted. For an insurance beneficiary, awareness of the scheme’s entitlements and limitations is needed as an extended component of self care. When a person is recruited into a health research study, such as a drug or vaccine trial, it is necessary to acquaint oneself with the protocol, possible adverse effects and safety measures.
Self care can extend to support provided by lay members of the family or community. Persons with serious illness or major disability often require such support. At the community level, ensuring sanitary conditions in the locality, prompt garbage disposal, controlling air pollution, making sure that public places are free of tobacco smoke and exhorting people to follow Covid-appropriate behaviour would all amount to collective self care. Patient support groups are valuable resources for extending care while patient advocacy groups are effective in advocating causes such as assured access to essential medicines at affordable prices.
Self care redefines the construct of medical care by enrolling the patient, family and community as partners to the physician in defining and delivering appropriate care that is designed to a person’s needs. This is a philosophy embedded in many traditional systems of medicine but modern medical systems are now beginning to recognise its democratic spirit and respect its strength in delivering better health outcomes.
(Views are personal)
Dr K Srinath Reddy
Cardiologist, epidemiologist & President, Public Health Foundation of India
(ksrinath.reddy@phfi.org)