Managing chronic disease

Increasingly the main business of doctors is managing patients with chronic not acute disease. Even when doing “acute things” like operating, doctors have to remember that their patients are likely to have chronic disease. A randomised controlled trial shows how preoperative optimisation of oxygen delivery reduced mortality from 17% to 3% (p 1099). Mortality was so high in the controls because three quarters of the patients had at least one medical condition.

Good clinical skills are needed to treat both acute and chronic disease, but organisational skills are …