"The trouble is that there are those patients who do it all already anyway and then those patients who just never will..."
I couldn't disagree with this statement in principle (there are people at both ends of the self-management spectrum), but when shared as an argument not to engage in supporting self-management (as it was used), it couldn't be more floored.
Lets break this down...
First of all, we can say this about many clinical interventions that we seem to carry on prescribing regardless. Some medications will never work for some people - even RCTs are honest about that. Some (short term) symptoms would have naturally resolved themselves without any medications. Yet we continue to prescribe these medications! That doesn't seem to be enough of a reason not to use traditional clinical interventions, so why should it limit self-management support as well?
Secondly, self-management support isn't black and white. From an asset-based approach, the people who 'never' self-management are actually already doing some things to self-manage. They might be tiny and clinically insignificant, but that doesn't mean that individual isn't making (wise or otherwise) decisions on a daily basis about their health.
Those people who are already doing it are probably doing so despite the system, and would probably still welcome some acknowledgement and support - I know I did and many people I work with do too. Just because they are doing it all already at the moment, doesn't mean they feel confident sustaining it all, or will encounter challenges in the future that they could prepare for.
And thirdly, if self-management is perceived as an all or nothing binary activity, that misses the spectrum of activities that is encompasses... medications, navigating services, managing symptoms, planning, goal setting, problem solving, social activities, peer support, information sourcing, emotional resilience, adapting hobbies, decisions re daily activities, communicating with friends, family and support networks....
I can't dispute that spectrum of people's knowledge, confidence and skills to self-manage (or the levels of patient activation as its often labelled) exists, but its a strong reason to support self-management because it means we can tailor our support. We don't need to put hours into support every patient, but can provide lighter touch specific support for some while focusing more with others. This is exactly what happens with clinical triage, and screening of referrals into acute services, so it's not unreasonable or unrecognisable for clinicians.
Whilst hearing these views is always a bit stomach-churning, it is so helpful to then check back how people are perceiving self-management and what further we need to do to support and embed the self-management agenda, or even establish understanding of what it is in the first place!