Knowing as practice: Self-care in the case of chronic multi-morbidities

Abstract

Patient expertise in self-care is recognised as a cornerstone of disease management in advanced welfare capitalist societies. When conceptualised within a broader agenda of 'engaged and active patients' such expertise is expected to relieve UK NHS resources significantly. However, although self-care is first and foremost an embodied practice, grounded in the context of everyday life, state sponsored self-care support initiatives such as the Expert Patients Programme operate a dualistic framework separating cognitive and corporeal elements. Moreover, chronic disease management operates through a framework that is increasingly biomedical, specialised and reductionist. Patients with multiple morbidities in particular are not served well by this epistemological approach. Utilising a 'lived body' conceptual paradigm and drawing upon qualitative data gathered from interviews with patients with multi-morbidities, we explore embodied self-awareness in health and illness and the everyday practices of chronic illness work. We examine how patients integrate the different types of knowledge and practices resulting from interaction with primary care professionals and highlight the implications for primary care practice, for medical epistemology and for the democratic potentiality of the NHS. © 2012 Macmillan Publishers Ltd.