Wilson and coworkers noted that self-care is a key to managing resources in chronic disease and as a right to patients. The Chronic Disease Self-Management Program developed in the United States has been adopted in a number of countries. In England, it has been as adapted as the Expert Patients Program. However, despite its potential as a lay-led initiative, the program has been criticized as pushing the medical model and failing to reach patients in most need. The authors critiqued the Expert Patients Program, and drew upon a qualitative study to explore whether the program enables patients to be more involved in the patient-professional relationship. An approach utilized focus groups, in-depth interviews, and participant observation. Data were gathered from 66 individuals with a chronic illness who were knowledgeable, active, and informed. A number of characteristics common to expert patients were linked to a systematic, proactive, and organized approach to self-management; a clear communication style; and the ability to handle emotion. The study included participant observation of an Expert Patients Program and a professional-led self-management course. A paradoxical nature of the Expert Patients Program was revealed in that while there was evidence that it reinforced the medical paradigm, there was a concurrent support for the subjective experience of living with a long-term condition. Furthermore, while the policy emphasis has been on individual action within the Expert Patients Program, there is some evidence that it may be triggering a health consumer movement.

VALUE OF STUDY TO READER: The study showed that as patients are taught self-management skills, they become more active and proactive in taking care of their own health. They become, in short, effective consumers of health care services.

P.M. Wilson et al. The Expert Patients Programme: a paradox of patient empowerment and medical dominance. Health Social Care & Community, 2007;15:426-438.