It's less valuable, perhaps even harmful, when the parental attitude is used when somebody comes in with a stress-related illness. If the doctor just gives these people a Valium and a pat on the head, he or she may be doing them a disservice.

Doctors need to identify situations in which it is appropriate for them to say, "I can't deal with this effectively," and perhaps suggest that they make lifestyle changes or involve themselves with a self-help group.

You know, the basis of the whole problem of healthcare costs is that the provider almost always decides what the consumer needs. Health professionals make nearly all decisions about purchasing hospitalization, lab tests, drugs, physician's services, and so forth. When these decisions are made solely by the provider, all economic controls go by the boards. It would be like going to the grocery store and having the checkout clerk tell you what groceries you had to buy.

A self-care-educated mother monitoring the health of her children can make very useful health judgments about her child—saving time and effort and minimizing the need for professional services. Family and friends can, in many cases, provide better health care than any hospital, because they share the client's culture. So self-care offers some attributes far superior to what any professional could supply.

Some people in the alternative technology movement are calling self-care appropriate medical technology. Would you agree?

Very much so. Because we're not talking about bringing in vast new programs, run from the top down. We're talking about using resources we already have—and have been overlooking for years.

I wouldn't want to overemphasize health workers' resistance to self-care. A great many health workers are very excited about self-care, because it gives them an opportunity to get out of professional roles they find personally unsatisfying.

I couldn't agree more. I've always felt that physicians who tend to be curt and abrupt with their patients—who show their stress in their patient relationships—do so because of the strain of having to deal with the patients who appear passive and helpless, who come in demanding that the doctor do things he couldn't possibly do. If I were a physician, I'd much prefer working with assertive, educated clients who understand and believe they can and must participate in what's going on.

I've been on the faculty of a number of workshops devoted to self-care for health professionals and I've been struck by the way that health workers, especially physicians, when they start to trust you and really start letting down their hair, will say that they feel at the mercy of their patients.

These doctors feel harassed by endless forms and paperwork, and on top of all that, now the public doesn't love them any more. There's a lot o f stress, a lot of anger. And there's a wide-spread realization that they've gotten themselves into a role that's not very satisfying.

That is very interesting. Those kinds of workshops are an extremely valuable resource, because we're beginning to find more and more health professionals becoming—would you believe it—alienated.

Nurses have been feeling this way for a long time, and now alienation is creeping into other sectors of the health establishment. Medicine really is being demystified. The mystique is beginning to crumble—not only for consumers, but for the health workers themselves. They're beginning to ask, Who am I? What am I doing here? Who needs us, anyway? Are there other ways of being a hearth worker that would be more useful to myself as well as my clients? And so on.