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In Reply: Both of these letters reaffirm that patient self-management is a critical part, but only a part, of good chronic care. We see the systems approach to diabetes management fostered by Dr Etzwiler as a historical precursor to the chronic care model. The human immunodeficiency virus and acquired immunodeficiency syndrome experience of Dr Rukeyser and colleagues is a stirring example of the potential of the activated patient.

Thomas Bodenheimer, MD, MPH
Department of Family and Community Medicine
University of California
San Francisco

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:1509.

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