In his book Megatrends, John Naisbitt writes: "Of all 10 megatrends, none is more subtle, yet more explosive, than the shift from an industrial to an information society. I say this because of my experience in talking about this megatrend with people all across America. It always surprises me that so many people passionately resist the notion of an economy built on information and, despite a wealth of evidence, deny that the industrial era is over. I think this depth of feeling represents our collective unwillingness to say good-by to a magnificent era."

This resistance to accept the information age is particularly strong in the realm of health care.

On the most basic day-to-day level, the transformation from an industrial economy to an information economy means that we will rely more on information products (software), multiple source approaches, and informal networks, and less on products (hardware), single-source approaches, and professionals.

From Factory to Fitness Under the industrial model, health was seen as an assembly line process: A person with a health problem immediately became a patient. Webster's definitions of this word provide a chilling insight into the role a sick person was expected to play: "An invalid. Someone under a doctor's care. A long-suffering person. Some one receiving medical treatment. A sufferer or victim. Someone who bears annoyance, delay, hardship, and pain with fortitude and calm."

Patients were seen as "raw material" for the health care "factory"—the hospital or doctor's office. Once patients entered the medical system, each one received the same standardized approach—the history, the chief complaint, the physical examination, the differential diagnosis (a standardized process in which the clinician considers each possible cause of the chief complaint), and finally, the appropriate treatment. In the end, the patient either died or was sent home to follow "doctor's orders."

It was all very much like the assembly line at a Ford auto plant: The patient passed passively through the system while the doctors and other health professionals extracted information, performed diagnostic procedures, defined the problem, decided on an appropriate solution, then applied the chosen treatment. Patients were expected to be passive, compliant observers of professionally-provided care. An "uppity" or troublesome patient who asked too many questions, sought out other information sources, or asked to be included in the decision-making process, was viewed in much the same way as an auto assembly line worker might view a half-assembled truck that started to tell him how to do his job.

But this industrial-age vision of health care, while still extremely influential, is no longer the only game in town. A new information-age model is beginning to emerge. This new model sees the individual, not the physician, as the key player in the health care system. While the old model required the patient to be powerless, compliant, and passive, the new model encourages the layperson to be powerful, inquisitive and active. According to this new selfcare model, professional care is only a small part of the whole health care picture. The process by which we all gather health information, choose healthy behaviors, diagnose and treat our own ailments, and make use of professional services is seen as the very foundation of health care. Health is no longer just something doctors do. It is something we all do every day.

Let me tell you about a 62-year-old friend I'll call Dorothy. Three years ago, Dorothy developed pains in her legs and shoulders. Still operating on the old model, Dorothy visited her doctor and accepted his advice without question. The prescription she received produced unpleasant side effects. Her doctor substituted another medicine, which produced a different set of side effects. A third drug produced similar results—some relief, accompanied by annoying side effects. After three months of medical treatment. Dorothy's pain was markedly reduced. Her medical expenses for that period looked like this: Doctor's visits—$215 Medical tests—$92. Drugs—$86. Total—$403.

Earlier this year, Dorothy experienced similar pain. But by this time Dorothy had become a self-care enthusiast. She resolved not to leave things totally up to the doctor. She was ready to take her health care into her own hands.

She began, again, by visiting her physician. "We're still not sure exactly what it is," he told her. But when he reached for his prescription pad, Dorothy held up her hand to stop him.

"Please write down what my choice are," she told him. "I want to read up on them."

Her doctor wrote down the names of three drugs, the same ones she had taken three years before. Dorothy went to the library and read up on them. She was surprised to find that aspirin often produced equal or superior results. She began treating herself with aspirin.

A friend suggested acupuncture. She visited an acupuncturist and had a short course of treatments, with good results. An in-law from out of town loaned her a relaxation/healing tape. She subscribed to two health magazines and began taking a multiple vitamin/mineral insurance formula. She listened to the healing tape every night at bedtime. It eased the pain and helped her get to sleep.

At a friend's suggestion, Dorothy began an early-morning exercise class at the local pool. It seemed to help. She ordered a book on rheumatism and an information packet on rheumatic conditions from a consumer health information center. Another friend recommended a heating pad that supplied moist heat. Dorothy found it extremely helpful. This time her medical expenses looked like this: Physician's visits—$45. Acupuncturist—$60. Aspirin—$4. Self-Care information (three books, two magazine subscriptions, one information packet, one cassette tape)—$51. Self-care tools (heating pad)—$36. Total—$196.

At the end of three months her symptoms had improved remarkably. And Dorothy had entered the information age.