Patient Services in Chronic Diseases

Abstract

T HE HEALTH and medical care resources and facilities generally available in our country were developed in response to the demands of acute illness. It is now inevitable and desirable that these same resources be directed toward the demands of chronic illness, which has become the main preoccupation of those in the public health and medical care fields. In determining the changes in philosophy and facilities which our medical resources must undergo to deal with this new problem, it may be worthwhile to contrast the characteristics of the acute illnesses which have occupied us in the past with those of the chronic illnesses which will occupy us in the future. The most obvious characteristic of acute illness is dramatic onset. The healthy individual develops signs and symptoms such as sharp pain, high temperature, or coughing of blood which make clear to the patient, to the family, and to the physician that serious illness is present. In acute disease the length of illness is usually brief, most often measured in days, and the illness is marked by a crisp, definitive end point. Most often the patient makes a complete recovery, returning to good health and the activities, pursuits, and responsibilities which characterized his life before the acute illness. The characteristics of most serious chronic diseases are so different as to be almost the obverse side of the coin. The onset of many of the chronic diseases is so insidious that often the individual will not clearly recognize that there is anything seriously wrong with him. There is no qualitative relationship between the presenting symptoms and the severity of the underlying disease. Diabetes is a very serious illness whose sequelae are disabling and often deadly. We are all familiar with the damage to the cardiovascular system which leads to heart disease, kidney failure, gangrene of the extremities, blindness, and other complications of diabetes, and yet it is commonly stated that more than a million Americans who have the disease are not aware of it. The reason is obvious; the initial symptoms may present such small deviations from the normal that neither the patient nor his family knows that anything is seriously wrong. By definition the duration of chronic illness is measured not in days but in weeks, months, and years. Again in distinct contrast to acute illness, chronic disease usually does not have a sharp end point with complete recovery; more often disability and handicap remain for life. The problems that face the individual, his family, and society in the care of the chronically ill are due to insidious onset, long duration, and disability.