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To the Editor: Dr Bodenheimer and colleagues¹ examined patient self-management education in the context of the chronic care model that emphasizes the interaction of informed activated patients and the prepared, proactive practice team.² Their presentation of the case of 2 brothers with significant chronic disease, however, illustrates the primary importance of a prepared, proactive practitioner as a motivator of effective patient self-management. As illustrated, both brothers were able to adopt positive self-management behaviors, albeit at different rates, without the benefit of self-management education.

We agree that patient self-management education has an important role to play in helping some patients accept responsibility for their health and their part in collaborative care. This has certainly been true, in our experience, of patients with human immunodeficiency virus and acquired immunodeficiency syndrome. However, as evidenced by Ricky, the less compliant brother, a small change in physician attitude and behavior may be all that is . . . [Full Text of this Article]

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