Dr. Mary Howell: Medical Self-Care Advocate

In this interview Dr. Mary Howell discusses the role women have traditionally played as healers and how the she came to prefer a healthcare model that empowers patients to practice medical self-care.
By Dr. Tom Ferguson
July/August 1981
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Dr. Mary Howell encouraged the practice of medical self-care at every stage of life.
ILLUSTRATION: FOTOLIA/LEREMY


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This issue's column is a summary of a recent conversation between Dr. Tom Ferguson and Mary Howell. Dr. Howell holds an M.D. and a Ph.D. in psychology from the University of Minnesota. She was the first full-time woman pediatrician at Massachusetts General Hospital, and the first woman to serve as associate dean at Harvard Medical School. Mary is also the author of three books (Why Would a Girl Go Into Medicine?, Helping Ourselves: Families and the Human Network, and Healing at Home: A Guide to Health Care for Children), and is the women's health editor of Medical Self-Care magazine. 


FERGUSON: It is estimated that 80% of the attention given to ill people is provided by nonprofessionals and that almost all such treatment is handled by women. In other words, most health care is provided by nonmedically trained females. Why is that?

HOWELL: Because the great majority of human ills are too unimportant and commonplace to interest doctors. Problems such as colds, lower back pain, digestive, bowel, and urinary irregularities, general aches and pains, and the vast range of emotional difficulties are rarely life-threatening, but they may have a profound influence on the quality of a person's life. The task of caring for such problems has traditionally fallen to women.

Therefore, although most folks usually think of healers in terms of male physicians, it would be more accurate to think of our "medics" as being predominantly laywomen. On my office wall I have a picture of an old woman holding a baby. Beneath it, there's a quote from Adrienne Rich:

My heart is moved by all I cannot save: so much has been destroyed I have to cast my lot with those who year after year, perversely, with no extraordinary power, reconstitute the world.


That's what women have always done: They've reconstituted the world, without the help of any extraordinary power.

FERGUSON: So far we've discussed the illness side of health. How about the wellness side? How much preventive health care is provided by women?

HOWELL: A great deal. In fact, illness prevention is what most homemaking and child-rearing chores are all about. Unfortunately, in the last few decades medical professionals have badly undermined women's traditional role in both illness and preventive health care by saying, "You don't know how to do it right, so you'd better ask us."

FERGUSON: What role do you feel family and friends should play as resources for home illness care?

HOWELL: A big one. Mothers often have real internal conflicts about telling doctors, "My Aunt Jean always does so-and-so when she's sick like this." People feel it's inappropriate to talk about home remedies in a doctor's office. But it may well be that the doctor doesn't know what to do and Aunt Jean does!

I remember when I first started my practice—I'm embarrassed now to think about it—a mother would come in with a baby who had a cold and ask if applying Vicks VaPoRub would do any good. I'd say, "Of course not!" I considered myself a scientist, you see, and I hadn't seen any AMA-approved studies about chest rubs. However, it's clear to me now that personal attention, touch, and caring are all critical parts of healing. Therefore, rubbing on Vicks can be a significant healing act!

Widespread belief in the myth that health workers have near-absolute control over illness makes patients reject their own considerable powers to manage sickness for themselves. Anybody who's been on the clinician's side of the stethoscope knows how little we usually have to offer and how often we just make our programs up as we go along. People's problems rarely fit into the nifty categories that doctors learn in medical school.

Back in the late 1960's, I changed my own ideas about what a doctor should do. This "conversion" had a lot to do with my involvement in the women's movement. I wanted to step out of the magical doctor role I'd been trained for. I felt it would be more appropriate for me, the pediatrician, to be a backup resource, to simply assist the mothers who were doing the real healing. Now that decision involved a pretty revolutionary departure from the way I'd been taught to practice pediatrics, because medical education generally teaches doctors to do everything possible to "rescue" children from their "terrible" parents.

FERGUSON: But surely you feel it's sometimes appropriate for doctors to take over the healing process.

HOWELL: Of course, but only if that's the patient's 'or the parent's specific request. The problem is that doctors are taught to take over all of the time.

FERGUSON: The pediatric practice you had sounds like it could serve as a worthwhile medical model for those who'd like to change their healing roles. How did you set it up?

HOWELL: Our clinic, in Maine, was run collectively by four women: a registered nurse, a licensed practical nurse, a coordinator, and me. We offered self-care classes for parents in which we taught the basics of giving physical exams and dealing with common illnesses. The experiences we had during those classes provided the nucleus for my book Healing at Home.

Our center had a parents' advisory group too, and we health workers listened to the advice it offered. We also published a clinic newsletter and did a good deal of health education, both in the local schools and with community groups. We even provided the parents with copies of their children's medical records.

FERGUSON: What happened when you gave people access to such records?

HOWELL: The most surprising result was the effect that doing so had on me. I think I'm a pretty conscientious doctor, but I was astonished to see how much I'd been bending a patient's written history to fit the "classic cases" I'd read about in medical school. When I realized I was writing chart notes for the mother's eyes, though, I became much more accurate.

FERGUSON: Do you have any overall plan for working to humanize our society's system of medical care?

HOWELL: That's far too big a problem for me to handle. I think I can only suggest some ways in which an individual can work toward getting (and giving) better care. One way is to take a friend along when visiting a doctor. Anyone doing so should just tell the health worker that he or she would like to have a friend in the examining room. The clinician's reaction will be a pretty good sign of whether or not the patient will get the kind of care he or she wants. The friend can also help the ill person continue to insist upon getting information until all of his or her questions are answered.

I also think that women who give birth in standard hospital settings should take along an advocate if they can, somebody in addition to the child's father. After all, it's sometimes difficult for the father to be objective about what's happening at such a time.

Another way to work toward improving your health care is to join—or form—a medical consumer group, preferably one with broad community support. Such organizations carry a lot more weight than do individuals.

Finally, I'd urge folks to be very supportive of any health workers who do provide the type of care they like. Such people often catch a lot of flack from their colleagues.

FERGUSON: Is America's health care system really changing?

HOWELL: I think so. I like to give folks two seemingly contradictory pieces of advice when I'm talking about trying to change the health system. First off, I recommend that my listeners be patient. People have to recognize that doctors and nurses have been trained all wrong. Many of us are attempting to change, but our education often gets in the way. So I advise my patients not to write health care people off too quickly. If a person has a bad experience with a doctor, I advise him or her to wait until the anger has passed, then go back to the clinician and try to talk the problem out.

On the other hand, though, I tell people never to accept anything less than the good care they deserve. No one should ever let a health care worker walk all over him or her.

FERGUSON: Do you have any further advice you'd like to offer?

HOWELL: Yes. Anyone who's interested in self-care and women's health should consider joining the National Women's Health Network. The network has become one of the most influential consumer health lobbies in Washington. It publishes many resource guides and an excellent newsletter.

The network functions as a women's watchdog over the health industry. Recently, a network research project unearthed a study showing that some women whose mammograms were positive—and who had breasts removed as a result—turned out not to have had cancer. It seems that the agency that sponsored the study told only the women's physicians about the mistakes and not the patients themselves. Both women and men need direct access to this kind of information, and the network helps to press for it.


In 1976, Tom Ferguson—then a fourth-year medical student at Yale—launched a magazine called Medical Self-Care, which he hoped would serve as "a Whole Earth Catalog of the best medical books, tools, and resources."  

Tom spoke of his plans for the publication and of his conviction that self-care could raise the general level of health in this country and lower our inflated levels of medical spending in a MOTHER EARTH NEWS interview, and left no doubt that he would work toward making those "dreams"come true.

Well, Tom Ferguson is Doctor Ferguson now, and the medical self-care "movement" — as well as Tom's magazine — has flourished. People are beginning to assume more responsibility for their own well-being and are eager for information that will help them take better care of their bodies.

So in an effort to provide just such very necessary data, MOTHER EARTH NEWS offers this regular feature by Tom Ferguson, M.D.
 


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