Bmj Usa: Letter


BMJ 2003; 327 doi: (Published 18 November 2003) Cite this as: BMJ 2003;327:E5

This article originally appeared in BMJ USA

The paper by Jones et al provoked a spirited response on As of January 13, 11 e-letters had been posted in response to the paper, three of which are published below (in whole or in part).—Editor, BMJ USA

Self management plans: Not a sticking plaster to be applied uniformly

  1. Rod Lawson, consultant (
  1. Royal Hallamshire Hospital, Sheffield, UK
  2. Wellstar Physicians' Group, Marietta, Georgia, USA
  3. Minchinhampton Surgery, Stroud, Gloucestershire, UK

    Editor—The article by Jones et al suggesting that there is widespread dissatisfaction with the concept of self management plans is thought provoking. However, the sweeping conclusions are difficult to justify. “We found that many patients with mild to moderate asthma …,” they say, although they used a sample of only 32 patients, 12 of whom were deliberately selected as being clearly noncompliant. I can certainly think of examples in which patients have been clearly helped by the provision of written self management plans. Perhaps, therefore, I should add balance to the debate by making the statement that many patients with mild to moderate asthma find written management plans invaluable. My personal series of cases is far greater than 32 patients!

    Less frivolously, I think the important point to be made is that self management plans are not a sticking plaster to be applied uniformly to all patients. In the same way that some patients will get on best with a metered dose inhaler and some with a dry powder inhaler, so there are patients who will …

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