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The thing that really sold me on patient self management is that it allows you to move from being an adversary of the patient in a way to putting your chairs together to be common problem solvers. And this comes up so often because so much of the work that we do as health care providers is to help patients make behavior changes. Taking the self management role allows you to have a whole different look at how you work with your patients and how you come at solutions that will help improve their health. I was impressed when I came here with the burden that CF presents to people and their families and I do believe that that's why self management support is critical because we need to help people navigate through that and still be optimistic and hopeful and have a life.

If it doesn't get done at home, it's not going to get done and then we'll do a rescue when they come to the hospital. They come into the clinic sick, we put them in the hospital for a couple of weeks. We do all this intensive care. We get them back to their baseline. But to stay at the baseline or to improve, if they don't do it at home, it doesn't happen.

If we tell them what to do by the time they leave the health center, they forget what we tell them and they don't follow through. With self management support we take small steps. It's a process and we do actually follow patients, meaning we encourage them to call us, to tell us what their small little aha moments are. And they do do that and they are very proud of their little moments. And so we walk along side them through this process.

This is very important for me because not only am I able to communicate with the patient but also better communicating with the provider. Prior to this program you just saw the patient and just gave the chart to the provider but now we have to talk about what's going on with the patient, we have to talk about the process, we have to talk about the plan.

One of the things that we found when we started doing patient self management is that it improved communication among everyone. Among the patients, the nurses, the front desk staff, the clinical team as well as patient to provider. So that we were working better with our colleagues in addition to working better with our patients.

Most long-term primary care practices are about chronic care management and this is the kind of thing, the team approach, self management techniques, the collaboration between a doctor and a patient, a provider and a patient, this is something that is exactly what we do all day long every day. To work on this model means that you're going to do a better job. You're going to give better care. You're going to have patients who are more satisfied. And you are going to feel like you do more in less time. So can you think of something you'd like to do?

They're in control actually all the time anyway. So why not let them manage their own care at home because you're not going to be there and it's not your goal, it's the patient's goal. They have to be willing to make a difference for themselves. The whole idea of self management when you're talking about a chronic illness like HIV is immensely important because what good is a pill if the patient won't take it? This chronic illness really depends on the patient's buy-in to target the behaviors that we are trying to change.

How are you feeling? Doing okay? Any new problems since I saw you last? I learned so much more about my patients when I started using this approach. Things that I never knew before because I wasn't asking the right questions. The information that I learned from my patients when I asked open-ended questions when I asked them what was most important to them about their health gave me information that I could use to help them work on their health care problems.

Letting the patient lead the way is important. Then when they see success, it's rewarding for both of us. Yes, I listened to them, to see what their needs were and they did it and now they feel better so we are both winning.

We've had some successes where patients have said to us please don't go back to the old way, the traditional way. We like that everyone is involved in our care. That's a wonderful thing to hear from patients. They see that it's a positive team approach. People think it's going to take more time to practice self management and the reality is that it takes less time. We have happier clients. We have less phone calls… It's an amazing a relief of burden on our system. It's totally changed my view about practicing medicine and coming to work. It just makes it so much easier and more joyful. People are happy I think. And I feel happy after the day is done.