The Demedicalization of Health Care
One of the topics in the previous chapter was behavioral modification: lifestyle changes in diet, smoking, drinking, exercise. In this chapter we look briefly at some of the things people can do for themselves in testing, diagnosis, treatment.
The positive feedback between an enlarged health care industry and a bloated definition of disease does have external limits. Like a pendulum, the more it swings in one direction, the farther it is likely to swing in the opposite direction. Many current varieties of health nuts, following the doctrine "Patient, be thy own physician, heal thyself," are harbingers of potential mass desertion from health care institutions and personnel. One can see an about-face in the medical profession, toward prepaid medical care, even to some halfway house to a nationalized system of health insurance, as a last-ditch defense of territory. Some of the increase in health care spending is only a transfer of health care from the household to the office and hospital. A reverse transfer is possible, desirable, and perhaps coming.
The most common medication is self-medication. It is mostly used for minor ailments but is significant even for major medical problems. It cannot be proscribed or eliminated. It is the ultimate constraint on the monopolization of health care by M.D.s. It often means self-diagnosis and self-treatment, or self-treatment without diagnosis, in direct response to symptoms. It may also mean a follow-up on medical diagnosis and treatment under the instructions of a physician.
With illness, the first decision, whether or not to treat, is made in the household. If the decision is to treat, then the second decision, whether to