Chronic Disease

Objectives

1. In a patient with a diagnosed chronic disease who presents with acute symptoms, diagnose:
   • acute complications of the chronic disease (e.g., diabetic ketoacidosis).
   • acute exacerbations of the disease (e.g., asthma exacerbation, acute arthritis).
   • a new, unrelated condition.
2. Regularly reassess adherence (compliance) to the treatment plan (including medications).
3. In patients with chronic disease:
   • Actively inquire about pain.
   • Treat appropriately by:
     • titrating medication to the patient’s pain.
     • taking into account other treatments and conditions (e.g., watching for interactions).
     • considering non-pharmacologic treatment and adjuvant therapies.
4. In patients with chronic disease, actively inquire about:
   • the psychological impact of diagnosis and treatment.
   • functional impairment.
   • underlying depression or risk of suicide.
   • underlying substance abuse.
5. Given a non-compliant patient, explore the reasons why, with a view to improving future adherence to the treatment plan.