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 Self-Care: The Rise of the Medical Prosumer  
 
The term "prosumer" was coined by futurist Alvin Toffler in his book The Third Wave. Toffler suggests that for most of the last 200 years, our society has been divided into two groups: the producers, who make or deliver our goods and services, and the consumers, who use them. He believes that one of the hallmarks of the new information age is the rise of a third group, prosumers, who produce many of their own goods and services.

Thus while a consumer might go to the local McDonald's, a prosumer might shop at a local natural food store, pick some vegetables from a home garden, and whip up a tasty, nutritious meal. The term "prosumer" is a most fitting term for those of us who have a strong personal commitment to self-care.

Physicians usually call their clients patients, or, more recently, health consumers. Both these terms have always made me squirm. My dictionary defines patient as " . . . a sufferer . . . one who bears misfortune, provocation, or pain without complaint.... an invalid.... a long-suffering person who is compliant and resigned."

So much for "patient." "Health consumer," isn't much better. We don't really "consume" health, nor do professional health workers produce it.

Based on statistics derived from his market research, John Fiorillo of New York's Health Strategy Group and I have described three levels of selfcare involvement: People minimally, moderately, and strongly committed to self-care. I've come to think of these three groups as passive patients, concerned consumers, and health-active prosumers:

1975 1987-1988 2000
Passive Patients 85-95% 55-65% 30-40%
Concerned Consumers 5-10% 30-35% 40-50%
Health-active prosumers 1-2% 5-8% 20-25%

If our predictions are correct, the number of health-active prosumers should grow more than 10-fold by the year 2000.

Who are these new health-active prosumers? They're the ones who feel responsible for their own health, who believe that they can do more to keep themselves healthy manage illness problems than their doctors can. They're the ones that order the vegetarian special and the salad with oil and vinegar on the side. Get up early enough and you'll see them in your neighborhood, running or walking to stay in shape.

Who are these new health-active prosumers? Get up early enough and you’ll see them in your neighborhood, running or walking to stay in shape.

Many passive patients feel they needn't worry about their health. When they fall ill, some magical doctor will make everything all right. If they develop heart disease, their doctors will simply pop in an artificial heart.

Health-active prosumers no longer subscribe to this old Marcus Welby model of medicine. They have a much more realistic understanding of what doctors can and can't do. They know that heart disease risk increases with smoking, stress, high blood pressure, lack of exercise, and lack of social connections, and they no longer harbor unrealistic expectations of being "saved" from self-induced illness. They work hard at keeping themselves healthy because they know that if they fall ill, there may not be much their doctors can do.

Passive patients expect doctors to take care of them. In exchange, they are willing to be helpless and passive, giving physicians the control.

Concerned consumers want to participate as respected junior partners in the doctor-patient relationship. While they may ask questions and seek out second opinions, they generally go along with whatever the doctor recommends.

Health-active prosumers, on the other hand, take care of themselves— either on their own or with the help of whatever advisors or consultants they choose, be they orthodox or alternative. They frequently seek advice, but generally retain the final decision for themselves. They do not hesitate to disagree with their health advisors.

Although they may consult physicians, health-active prosumers do not commit themselves in advance to follow their doctor's orders. If they aren't satisfied with a doctor's opinion, they have no qualms about seeking additional information, trying new approaches, or simply waiting and watching.

Health-active prosumers appreciate physicians who listen and are willing to negotiate. They like to pinpoint areas of agreement and disagreement, and hammer out a mutually acceptable compromise. This process, similar to that found around any bargaining table, is all too rare in doctor's offices.

Health-active prosumers prefer physicians who communicate clearly and respectfully, avoid jargon and time pressure, and keep interruptions to a minimum. A physician shows respect by listening without interruption, by making eye contact, and by responding directly to both spoken and implied questions. Doctors who interrupt constantly, who refuse to be interrupted, who use such common responses as "Let me worry about that," or "Don't concern yourself with that," or who conclude a complex set of instructions with a hasty, "Any questions?" will in all likelihood not see the health-active prosumer a second time.

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 About The Author
Tom Ferguson MDTom Ferguson, M.D. (1943-2006), was a pioneering physician, author, and researcher who virtually led the movement to advocate informed self-care as the starting point for good health. Dr. Ferguson studied and wrote......more
 
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