As we got to know each other better, a lot of anger toward the health-care system started to come up. Frustrating experiences. Times when they'd been treated insensitively.

The old authoritarian doctor image was hanging over our heads, even though I wasn't the typical authoritarian doctor. There was a lot of asking, is this something that's okay to talk about? Is it all right for me to ask this question? And when I made it very clear that it was, they really began to share their experiences and concerns. They began to express feelings they may never have expressed to anyone before—certainly never to a physician.

It soon became clear that they had a lot of health needs that weren't being met by the health-care system. They'd been put down and ripped off. The women's movement was beginning to be active around that time, and the women especially were beginning to look at their lives in some new ways.

Pretty soon people started saying, "Why can't I take my father's blood pressure?" "Why can't I give my kids allergy shots?" "Why can't I use an otoscope to look in my little boy's ear when he has an earache?"

And I found myself saying, "I don't know why not. Let's do it." So the whole course evolved out of the things people were asking.

Had there been any other similar classes up to that time?

No, to my knowledge, it was the first class of its kind. There had been orientation tours for new patients in certain clinics and patient education for some specific diseases like diabetes, but nobody had ever really gotten into this area before.

How would you define this new area?

1 think of it as directed toward a new kind of medical consumer, what I call the activated patient. In my Herndon class, their questions went well beyond the boundaries of what had been thought of as patient education at that time. They wanted to know why they couldn't have their own black bags of medical tools at home. No one had ever thought of teaching laypeople to use such tools before. There weren't any models for that. So we just had to go along and figure out how to do it as best we could.

What motivates a person to take a self-care class?

We've looked at that, and there seem to be seven basic reasons people give, over and over, for their interest in self-care:

1. wanting to save money on health expenses;

2. wanting to be able to take better care of their family's health, to be able to make effective family-health decisions;

3. wanting to take more responsibility for their own illness care—like hypertensives who want to be able to keep track of their own blood pressure;

4. wanting to learn how to hook into the medical system like a number of older people who outlived their doctors and weren't able to find a new one they were satisfied with;

5. wanting to learn more about their bodies and how they work;

6. people with illness in the family, wanting to feel more confident in dealing with it;

7. people who've gotten turned on to healthier life styles, wanting to hear more about jogging, nutrition, yoga, meditation, and whatever else there might be to this whole healthy lifestyle business.

Oh, yes. Of the really alternative approaches to health, yoga is the main one we've used—mainly because a neighbor of mine happened to be a fine yoga teacher. If I'd lived next door to a Thai chi teacher, we might have included that. The introduction to yoga has certainly been well-accepted by our students.