Increasing emphasis on self-care will require major changes in the
relationships between health workers and their clients. No one I know
has thought longer or harder about this relationship than John Travis.
John Travis and his six co-workers at the Wellness Resource Center in
Mill Valley, California, do not practice medicine. They promote
wellness. Their model is educational, not pathological. They see no
patients, prescribe no drugs, perform no physical examinations. If a
client is ill, he or she is referred to another physician for
diagnosis and treatment.
It isn't that Travis isn't qualified to treat the sick. John graduated
from Tufts Medical School and the Johns Hopkins Medical Center
residency program in preventive medicine. But he found that even the
kind of "preventive medicine" taught there was too illness-oriented.
The Wellness Resource Center is the result of his personal quest to
shift medical orientation from sickness to health.
Tom Ferguson: John, maybe you would start by describing the
kind of relationship that exists between conventional health workers
and their clients - and why you have tried to change that model.
John Travis: I think that most health workers are trained to
want to rescue people - and most people go to health workers to be
rescued. Traditionally, Western medicine has viewed disease as
something out there, beyond the patient's power or influence. When
disease strikes, you go to the doctor and he attacks the symptom with
the weapons of modern medicine. The doctor assumes total
responsibility, and the client becomes just a sort of unconcerned
I call this the pill-fairy model of health care.
TF: What's the alternative to the pill-fairy model?
JT: Taking a lot more self-responsibility. The pill-fairy model assumes that health is simply the absence of symptoms, that someone who doesn't have any symptoms is healthy by definition. But that's not true at all. There are as many degrees of wellness as there are of illness.
Medical education focuses on diagnosing and treating organic syndromes of disease. It's frustrating to health workers when people come in who have no specific physical symptoms, but are bored, tense, depressed, anxious, or just generally dissatisfied with their lives.
TF: You're saying that the treatment model doesn't work with them.
JT: Right, though the treatment model is appropriate in some cases. Particularly in something like, say, bacterial pneumonia or acute appendicitis. If I had one of those illnesses, I'd want my doctor to use pills or surgery.
TF: What should a health worker do when somebody comes in who's just bored and anxious?
JT: I think that once a specific organic illness is ruled out, they should turn them over to wellness educators.
TF: And what would a wellness educator do?
JT: The kind of thing we try to do here at the Wellness Resource Center - help people focus on the ways they are presently conducting their lives, suggest that other options are available, and support them in trying some of the options. The important difference from the pill-fairy model is that we make it very clear that we're not providing diagnosis and treatment, we're providing education.
We leave the responsibility for their own health squarely on their shoulders. It's damn near impossible for a physician to do that. Existing doctor-patient relationships are set up in such a way that the doctor carries all the responsibility, makes all the decisions, calls all the shots.