Diary studies suggest that as few as one in 40 symptoms ever reaches a medical consultation. The reasons for doing so are complex and include severity of symptoms, their impact on quality of life, other events in patients' lives, and patients' health beliefs. 5 Patients obtain information about their symptoms from a range of sources, although little systematic research has been carried out on the factors which inform healthcare seeking decisions. Self care is, of course, not only important at the lay-professional interface but permeates the health system. Concepts such as patient enablement 6 and the concordance model of doctor-patient interaction 7 have been developed recently.
Self care is also an essential component of the management of chronic illness.
Recent policy developments, mostly centred around the desire to improve access, may have begun to tilt the balances across some of these interfaces. For example, the gatekeeper function of primary care, controlling access to expensive and invasive secondary care services, is an important component of a cost effective health service. The erosion of personal primary care in recent years, augmented by well intentioned initiatives to improve access, might well lead to escalating and inappropriate use of precious resources. Persuasive arguments for better access to services 9 need to be tested against an analysis of the costs as well as benefits of new arrangements. A large research agenda surrounds self care, which begins with the need to understand patients' constructions of symptoms and disorders, particularly when different cultural contexts may lead to dramatically different responses to illness.