The past few years has seen a gradual increase in the type and expertise of the medical care available. The result has not been an improvement in all of the care that is available. Some aspects of medical care have improved remarkably while at the same time some aspects have been neglected to a large extent. The provision of well equipped and staffed emergency rooms has resulted in far better care for injuries and many acute illnesses. Automobile accidents, gunshot wounds are given exemplary care in most situations. Acute illnesses, acute myocardial infarctions, strokes, pulmonary emboli and many other acute situations are handled in an exemplary fashion. Acute exacerbations of chronic illnesses are also generally well managed, continuity of care for these patients is one aspect of the things that have received less than optimal attention.
The management of chronic disease is often complicated and there are no simple answers. The literature regarding most chronic illnesses can be found easily, however, interpretation is not quite so simple. One of the first requirements in managing a chronic condition is objectivity. The ability of the patient to do this is extremely poor. Over the years I was able to provide care for many of my colleagues who as a rule were not able to provide good subjective evaluations when it came to their own illness.
Increasingly the burden of care for chronic illnesses has fallen into the hands of the patient or administrator. Many aspects of management can be difficult and the patient’s own evaluation is usually not very good. The physician still provides many factors and help in decisions that are required in the management of any chronic condition.
Chronic illnesses are common and frequent and should not get lost. Management and recognition of chronic illnesses is an important part of the practice of medicine even if our administrative overseers don’t understand it and don’t want to pay for this type of care.