Intended for healthcare professionals


Patients as partners in managing chronic disease

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:526

Partnership is a prerequisite for effective and efficient health care

  1. Halsted Holman, professor of medicine (,
  2. Kate Lorig, associate professor of medicine
  1. Stanford University School of Medicine, Palo Alto, CA 94304-1808, USA

    General practice p 550 Education and debate p 569

    When acute disease was the primary cause of illness patients were generally inexperienced and passive recipients of medical care. Now that chronic disease has become the principal medical problem the patient must become a partner in the process, contributing at almost every decision or action level. This is not just because patients deserve to be partners in their own health care (which, of course, they do) but also because health care can be delivered more effectively and efficiently if patients are full partners in the process.

    Today in the United States chronic disease is the major cause of disability, is the main reason why people seek health care, and consumes 70% of healthcare spending. The differences between acute and chronic diseases are seen in the box on the BMJ's website. With acute disease, the treatment aims at return to normal. With chronic disease, the patient's life is irreversibly changed. Neither the disease nor its consequences are static. They interact to create illness patterns requiring continuous and complex management. Furthermore, variations in patterns of illness and treatments …

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