The Emergence of the Self-Caring Patient

In the 1980s, healthcare professionals began to recognize the potential for patients with certain conditions – such as diabetes and chronic kidney disease – to become active participants in their own care. This involved sharing knowledge and techniques to empower patients in managing their chronic illnesses. Concurrently, patient associations, often supported by the medical community, started organizing peer support groups to exchange experiential knowledge.

This evolving paradigm gave rise to Patient Therapeutic Education (ETP). This newfound emphasis on education stemmed, in part, from physicians' desire to free up their time. Furthermore, in an era of welfare state retrenchment, it offered a means to reduce healthcare costs. This knowledge transfer fostered greater patient autonomy from the medical establishment and even played a significant role in improving patient life expectancy. A number of disease self-management and empowerment programs have been established in hospitals, further solidified by the 2009 French Hospital, Patients, Health, and Territories (HPST) law, based on the principle that patients are best positioned to understand their own needs.

This shift gave rise to the concept of the patient as both the cared-for and the caregiver, or the "self-caring" patient. Daily self-management of their condition allows patients to move beyond the role of a layperson and forge a partnership with medical expertise. The concept of the "expert patient" developed, reflecting a new relationship between the medical community and patients, where knowledge is transferred from healthcare professionals to empower patients to become experts in their own health (Boudier, Bensebaa, & Jablanczy, 2012).

These "new" patients are individually ill, in that they no longer pose a threat to those around them, in contrast to the status of patients during epidemics. The individualization of illness, coupled with the suffering experienced in chronic conditions, challenges traditional healthcare norms largely governed by medical logic. Health is no longer defined solely as the absence of disease but expands to encompass physical, mental, and social well-being.

Paramedical professionals are increasingly entrusted by the medical community with roles involving advice and education, with the understanding that they should use patient-friendly language to facilitate adherence to health recommendations. Simultaneously, the use of "alternative" or "non-conventional" medicine – medicine not recognized by medical authorities – grew significantly in the 1970s and 1980s (Cohen & Rossi, 2011).

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Footnotes:

21. Boudier, Y., Bensebaa, F., & Jablanczy, A. (2012). Le patient expert: une nouvelle relation entre malades et soignants. John Libbey Eurotext.

22. Cohen, P., & Rossi, J. P. (2011). Sociologie de la santé. Armand Colin.