The Political Context And Selfmanagement

The expert patient's programme holds out the promise of thousands of confident and more informed patients and large numbers of lay people involved in evidence based self-management programmes of one kind or another. However, in order to achieve this there will need to be a major shift in cultural attitudes, and this in turn will depend in part on convincing patients and professionals of the value of this approach (Donaldson 2001).

Because he is the Chief Medical Officer for England and Wales, Liam Donaldson's paper has significantly influenced the dialogue between service users and service providers. The document clearly states that the main challenges to the provision of a quality health service are not from acute, but from long-term disorders, because the latter are the predominant disease pattern in the UK and across most of the developed and developing world.

The paper found that comprehensive health programmes have not yet been provided, and Donaldson suggests that one reason for this is the failure to use as a resource the knowledge and experience of the individuals with long-term disorders. He recommends a fundamental shift in the way in which such disorders are managed, and central to this proposal is the active recruitment and involvement of "expert patients".

The expert patient may be defined as someone who has "confidence, skills, input and knowledge to play a central role in the management of life with chronic disease, and to minimise its impact on their day to day living". Essentially, this means that people with a long-term disorder take a central role in decisions about their problems. They must be regarded as experienced partners in the process of health care, instead of as inexperienced recipients of treatment (Lorig et al., 1993). It follows that policies to modernise the design and delivery of services within the National Health Service (NHS) must emphasise the role of patients as partners who share their expertise with other health-care providers.

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