Intended for healthcare professionals

Education And Debate

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

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:572
  1. Noreen M Clark, dean (,
  2. Molly Gong, senior research associate
  1. University of Michigan School of Public Health, 109 S Observatory Street, Ann Arbor, Michigan 48109-2029, USA
  1. Correspondence to: N M Clark

    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.

    Asthma: the knowledge gap

    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 …

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