Helping Patients Take Responsibility for Their Own Health

Patients consult a physician when they feel that a symptom requires expert assessment and advice. With a new problem, the physician generally makes the diagnosis, perhaps suggests some investigation, offers a treatment plan, and, it is hoped, explains it all to the patient. With an existing or a recurrent problem, the patient often already knows the diagnosis, may understand what investigation is needed, and has experience with the treatment. Therefore, he or she may not need to visit the physician—although professional confirmation and empathy may be welcome. Physicians practicing patient-centered medicine recognize such learning (1) and should encourage patients who can satisfactorily identify and investigate a problem and treat it appropriately; doing so saves time, effort, and money for all parties.

Patient self-management is widely used for some common chronic diseases (for example, diabetes and asthma). Many patients learn to manage their disease and monitor it by measuring blood glucose levels or peak flow rate; they can, within limits, modify their treatment accordingly, sometimes with support from a specialist nurse. Self-management of acute minor illnesses, such as the common cold and low back pain, is also common and is encouraged by health care providers. Similar systems for managing episodes of recurrent illness have been slower to develop. In this issue, Gupta and colleagues (2) report their evaluation of a patient-centered protocol for managing recurrent urinary tract infection (UTI) in 172 young women who attended the authors' primary care clinic.

The patients in this study had had two or more UTIs during the 12 months preceding the study. The research team taught …