Management of chronic disease by practitioners and patients: are we teaching the wrong things?

Abstract

The patient should be the primary manager of chronic disease, guided and coached by a doctor or other practitioner to devise the best therapeutic regimen.1 The practitioner and patient should work as partners,2 developing strategies that give the patient the best chance to control his or her own disease and reduce the physical, psychological, social, and economic consequences of chronic illness. In this article we consider the quality of education for patients and practitioners who are trying to manage chronic disease. We argue that neither patients nor practitioners are taught the skills that will most enable each to carry out his or her role and responsibility for disease management. We use asthma, a chronic lung disease, to show how patients and practitioners are being taught the wrong things. #### Summary points Disease control, especially asthma, depends on the quality of partnership between patient and physician Most current patient education activities are not adequately based on evaluated models of effective disease management One such model, self regulation, has been shown to change patients' behaviour and improve their health status Specific techniques can help doctors to develop partnerships with patients Including these techniques in doctors' education can lead to reduced use of and higher satisfaction with health care by patients with asthma We searched Medline and used previously published reviews to find articles on managing asthma. We did not formally assess the methodological quality of individual studies. In recent decades there have been striking advances in the clinical treatment of asthma,2 yet morbidity and mortality for the disease are at an all time high.3 This gap between the scientific evidence and the continuing negative effect of asthma on society depends to a considerable extent on patients' behaviour and practitioners' performance.4 To understand what patients and clinicians must be taught to …