Tom Bodenheimer and his colleagues have a nice short editorial in the British Medical Journal, Nurses as Leaders in Chronic Care.
... nurses, not doctors, are the key to implementing the chronic care model in a patient centred care team. By nature of their education and role, nurses are in a position to champion transformation of chronic care. In many nations, but not in the United States, nurses have been taking this central role for decades
That would be enough by itself, but catch this critique (all the citations are in the original):
A study of family physicians in the United States found that patients making an initial statement of their problem were interrupted by the doctor after an average of 23 seconds. Half of patients finish an office visit not understanding what they were told by the doctor. The commonest reason for patients not taking their medicines as prescribed is poor communication from doctor to patient. In a study of treatment decisions in over 1000 audiotaped outpatient visits to doctors, the patient was not involved in the decisions 91% of the time. Poorly informed passive patients are less likely to adopt healthy behaviours, and they have poorer clinical outcomes than informed, activated patients.
Given the attention we're finally paying to chronic illness, this should be pasted on the wall of every place that's designing or operating a chronic care program.
ps. Note that the third author is affiliated with the
Whatcom County Pursuing Perfection Project, which has been doing groundbreaking work in this area for years.