Portal de Periódicos da CAPES

Patient Self-management Skills Influence the Course of Glaucoma

1997; Elsevier BV; Volume: 104; Issue: 7 Linguagem: Inglês

10.1016/s0161-6420(97)30184-5

1549-4713

George L. Spaeth,

Stroke Rehabilitation and Recovery

Patient Self .. management Skills Influence the Course of GlaucomaGlaucoma treatments are variably effective, depending on the severity of the disease, the appropriateness with which they address the causes of neuronal deterioration, the skill with which they're applied by the ophthalmologist, and the faithfulness with which they're used by the patient.The importance of "compliance" in the outcome of any chronic disease, including glaucoma, is well known; other aspects of self-care and self-awareness are also important, although less appreciated.All of these are reflections of the patient's ability to manage his or her own life, and all affect the outcome of a chronic disease such as glaucoma.One aspect of "self-management" emanates from the patient's awareness of his or her own state of health.Some patients are exquisitely attuned to their bodies and note even minor deviations from optimal functioning, such as deterioration of visual acuity from 20/15 to 20/15 -2, a tiny opacity in the vitreous, or a slight decrease in ability to see at night.In contrast, other patients are far less aware of how their bodies are working -the classic example is the person whose vision is reduced to 20/100 in each eye due to age-related cataracts but who states that his vision is as good as it was 30 years ago.For most individuals, keeping their bodies in good working order is a high priority.As is true of all good managers, these individuals become promptly aware of problems and are quick to take the necessary steps to correct them.They are prone neither to denial nor "crying wolf."The problems they spot are real, and their approach to them is rational and appropriate.Some individuals, depending on their training, knowledge, and experience, are far more sensitive and far more able than others to evaluate accurately the significance of the signs or symptoms that they note.Self-management is at least partially related to cognitive knowledge.A person who is unaware that melanomas of the skin are often fatal and that early surgical treatment is highly effective is far less likely to seek medical attention than is the individual who knows such facts.Another characteristic of the person who is a good manager is the will or drive to do well.A well-developed sense that one can, at least to a certain extent, control one's own destiny is probably an essential characteristic of the person who manages well his or her own life.Some people are constituted to understand and, within limits, control that which affects their health or well-being.At the minimal level, such individuals are called "survivors" or "street smart."When such individuals become patients, they know that doctors are busy, are not omnipotent, and have a variety of conflicts of interest.When they believe they are getting worse and their physician tells them they are not, they challenge that opinion.When they are told to use a particular medication, they ask about side effects.If they feel the answer is inadequate, they read the package label or the Physicians' Desk Reference.They approach the physician with a list of questions and are not satisfied until their questions are answered.Such patients make sure that they understand what they need to do and why, and then they do it.Almost paradoxically, however, the people who best know how to manage their lives also know that they cannot do it totally on their own, and that they must rely on the knowledge of others who they respect and trust.Accordingly, these people make a major effort to be sure that those whom are going to affect their lives are people they can trust.