Intended for healthcare professionals

Analysis Spotlight: Patient Centred Care

The patient is the most important member of the team

BMJ 2015; 350 doi: (Published 10 February 2015) Cite this as: BMJ 2015;350:g7767
  1. Dominick L Frosch, fellow and associate professor
  1. 1Gordon and Betty Moore Foundation, Page Mill Road, Palo Alto, CA 94304, USA
  2. 2Department of Medicine, University of California, Los Angeles, USA
  1. Dominick.frosch{at}

Twenty five years after he had type 1 diabetes diagnosed, Dominick Frosch finds health professionals still fail to treat him as an equal in managing his disease

In January 1988, just before I turned 17, I was told I had type 1 diabetes. I had to learn to live with and take responsibility for monitoring and managing a chronic disease 24/7, 365 days of the year to prevent complications. 1 2 There is no day off.

The Diabetes Control and Complications Trial, which showed that intensive self management could limit and prevent complications of type 1 diabetes, was not published until five years after my diagnosis,3 but I was fortunate to get my initial treatment in a forward thinking German hospital that invited me to participate in a training programme. From day 1 I was taught that the management of my diabetes was in my hands. This made sense. I don’t live in a doctor’s office; nor was I particularly interested in spending a lot of time in one.

The concept of self efficacy—the belief that one is able to adopt a particular behaviour, was described over 30 years ago.4 My training programme instilled the belief that I could manage my diabetes and gave me the …

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