Dr. Tom Ferguson spoke at the Yale Medical School recently, and a funny thing happened.
The students overflowed the room, 90 or 100 of them, medical students wanting to hear about, of all things, medical self-care.
Furguson's only been out of Yale Med School for about three years, and, he says, with a trace of awe, "It's incredible to see the changes."
Three years ago Ferguson had been writing the thesis Yale requires from its medical students on "medical self-care," and he recalls, "nobody could have cared less. People thought we were a little nuts, sort of saying, "Well, that's very well, of course, but why don't you get into something like cellular biology . . ."
Ferguson is now 37. He started medical school quite late, at the age of 30, after nearly a decade of health-oriented, community-project work in migrant labor camps, suicide-prevention programs, free clinics, a king of healthful "power-to-the-people."
"After all," says Ferguson, not a bit apologetically, "I was a child of the '60s."
After he went back to med school, if he hadn't been radicalized already, he might have been then.
"I was very surprised and alarmed to see the kind of role I was being trained into . . . far from the community groups I was supporting and facilitating and brainstorming . . . now it became clear that I was being trained into a role where I was supposed to go in and take on all the power myself and sort of keep it away from the patient."
Result: A first-class career crisis.
Ferguson didn't know it at the time, but he was far from alone. He has since met many physicians who struggled through the same crisis that led him (and others) to the revolutionary conclusion that "We're now in a stage where clearly, by any statistical measure, the things individuals can do on behalf of their own health are ever so much more important than anything doctors can do." t
Feguson started his project with children, to see where the idea had come from, the ingrained idea that "health care was something doctors did, not what people did for themselves."
He found first that health-education literature suggests such topics as: "How To Brush Your Teeth." Or, "the Four Basic Food Groups." Or, "You Shouldn't Smoke."
Second, he found a group of first- and second-graders in New Haven, Conn., simply were not enchanted with those topics. A quick poll showed, in fact, their interest level in the three topics on everybody's health curriculum plan was "just about zero."
So Ferguson told them they could write their own ticket. "What do you want to know about?" he asked them.
"What's in your black bag?" they immediatly asked back.
By the time the 10-week course was over, the children had:
Demanded, and received, a stethoscope for each child because standing in line wasted time.
Invented a game of "How many sounds can you find in your body?" (Says Ferguson with a mock wince, "Believe me, they found sounds you wouldn't believe . . .")
Invented another game of "How many places in your body can you take your pulse?"
Divided class time into four sections: learning the parts of the physical examination; body-focus activity: meditation, yoga, guided imagery, relaxation techniques; question time (in which, says Ferguson, "We were astounded at the outright doctor phobias some of the kids had." Doctors meant shots. Doctors meant hurt.)
And finally, individual projects. One child did a dissertation on the cardio-vascular system which, says Ferguson, "showed a knowledge of the blood-clotting mechanism superior to that of most college graduates."
Videotapes of the New Haven project are available in many libraries, Ferguson says, to show teachers how imaginative approaches can produce mind-boggling results.
As Ferguson began to travel around on other facets of his project, he began to realize that there were scores, perhaps hundreds, of small unrelated health projects going on, all with similar underpinnings, but with no connection to one another.
From this realization, of course, developed Ferguson's now self-supporting quarterly, "Medical Self-Care," and his current book, "Medical Self-Care: qAccess to Health Tools," (Summit Books, $19.95 hardcover; $8.95 trade paper). The encyclopedia of the self-help movement bulges with lists of books, self-help groups from all over for almost anything, techiniques to explore, concepts to mull over, and some provocative writing, including one from science-fiction giant Ursula K. Le Guin on "Menopause: The Space Crone."
The book includes a description of the unsung, unrecognized and, of course, unpaid army of "lay health facilitators," the people you call for advice before you call the doctor, usually a mother or other family member, or a friend or neighbor.
"you talk about cost effectiveness," says Ferguson. "Some 96 percent of people who walk into the clinic door have either asked for or received advice or done something on their own behalf. Yet this whole resource, which is the main resource for health care, is totally ignored in our medical education system.
"What's more, over half the illness care in this country is provided by lay women, yet our image of health care providers is that of a male doctor. It's a case where the model does not fit the reality.
"And it is part of an underlying, invisible part of our health-care system that is not taken into account by health planners, not taken into account by people in the federal government supposed to be understanding and directing health systems.
"They're relying exclusively on professional sources and that's one of the reasons we're in a lot of the troubles we are now, in terms of cost, of quality of care, of patient satisfaction . . . or dissatisfaction."
For more information on Medical Self-Care, the journal, the book or the concept, or for information on the children's health project videotapes, write Dr. Tom Ferguson, P.O. Box 717, Inverness, Calif, 94937.