Doctors now know that taking an approach that systematically helps men who have developed "long term" or chronic diseases – such as Diabetes, Asthma, High Blood Pressure, Depression, etc.– to manage their own medical conditions works better than utilising the usual medical techniques that work for acute illnesses.
This is an important concept to understand. Whereas diseases like throat infections, skin rashes, urinary stones, gall bladder colics and appendicitis need assessment, diagnosis and immediate treatment by doctors, the chronic diseases need long term management – not only by the doctor and other health care professionals, but by the patient himself. In fact the most important person in managing chronic disease is the patient who has the disease.
Managing Chronic Disease
These chronic diseases cannot be cured completely, but with the correct approach and medications such "incurable" diseases can be successfully controlled.
In 2004, American doctor Edward H. Wagner proposed what is now termed the Chronic Care Model which focuses on improving health outcomes for people with chronic diseases through features such as:
- reorienting health services to provide Planned Care rather than ad hoc treatment for patients with acute conditions
- providing support for the patient himself, including the formulation and implementation of formal Management Plans
- providing patients with information about their condition so they understand what they need to do and why they need to do it
- encouraging teamwork between doctors, nurses, pharmacists and other allied helath professionals
- utilising community resources
It has been repeatedly shown that patients who take an active interest and are more active in managing their condition have better outcomes.
In simple terms, the old order , where the doctor tells the patient what to do and the patient does it, does not hold water in the 21st century. It works when the patient comes to see the doctor with an acute illness like a bacterial throat infection or renal colic for example. When it comes to long term management of a disease like Diabetes or Asthma or Heart Disease, however, the acute care "Do as I Tell You and Just Take These Medicines" model does not work.
These days, patients must become informed participants in their own health care because their day-to-day decisions can have a significant impact on their disease.
One way that a man's doctor can help him to improve his health – for instance, getting his blood pressure back to normal levels if he has hypertension or getting his blood sugar under control if he is a diabetic – is to educate him about his condition. The patient must understand what he needs to do and why he needs to do it, and then work according to a plan, setting himself Self Management goals
Patient Empowerment Through Information and Education
In managing long term diseases, the four most important points that patients who have diseases like Diabetes and Heart Disease need to understand are:
- Their disease is serious. If not looked after properly, these conditions will lead to complications and early death. Diabetics must realise that there is no such thing as a "not so serious" type of Diabetes! If they don't believe they have a problem, they will never make changes to improve their health.
- Their disease is essentially one that they have to learn how to manage. From what they are going to eat to whether they will go for a walk, it is the patient who has to make the decision, not the doctor. What the patient decides to do will have an effect on his disease. It is the patient who is the most important person when it comes to managing his illness successfully.
- It is the patient, as an individual with the disease, who has a Choice. A man has to understand his condition. and realise what benefits will accrue if he, for example, takes regular exercise, or takes the prescribed tablets regularly, or limits his intake of alcohol. Only he can decide if he wants to improve his health and comply with his doctor's advice.
- Patients can change their behaviour – albeit slowly. In small steps and setting one goal at a time, patients can change their behaviour – and doing so, manage their diseases effectively.
Sanjiva Wijesinha - Dr. Sanjiva Wijesinha, Associate Professor at Monash University medical school, writes on health, travel and medical topics.
