Bridging the gap: the patient-doctor relationship.

In January 2007 the National Heart, Lung, and Blood Institute (NHLBI) launched a national chronic obstructive pulmonary disease (COPD) awareness and education campaign: ‘Learn More Breathe Better’. This campaign is “finally moving [COPD] from obscurity to prominence” with the purpose of sending the message that COPD, although serious, is treatable, but also “to narrow the gap between what is commonly being done for COPD patients today and what can, in fact, be done” [1]. This is a very tall order, indeed, as it must satisfy the urgent need of physicians and patients for complete and credible information. For many years COPD has been what the patient spokesperson for the NHLBI awareness campaign calls fittingly “the Rodney Dangerfield of diseases”. It gets no respect. Others say that “O” in COPD stands for “obscure” or “overlooked” [2]. These sentiments are rooted in prejudice against the disease, which is considered by many inside and outside the medical profession as self-inflicted and shameful. However, more importantly, these sentiments reflect insufficient knowledge by physicians about the disease, its diagnosis, and available treatment. Coupled with lack of awareness of COPD by the population at large, and highly disproportionate allocation of funds for COPD research by the National Institutes of Health [3], these factors have a devastating effect on millions of patients, who expect prompt recognition of their acute health problems and hope for effective treatment. These misconceptions also precipitate rapid escalation of healthcare costs: $42 billion a year already. COPD is also the second leading cause of disability in the United States [2, 4]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) offers the international community comprehensive standards for the diagnosis and treatment of COPD [5]. These standards focus on four components of COPD management: (1) assessment and monitoring of the disease; (2) reducing risk factors; (3) managing stable COPD by applying education, pharmacologic treatments, and nonpharmacologic treatments; and (4) managing exacerbations in home and hospital settings. The implementation of the GOLD standards places increased demands on physicians and very importantly requires that patients are given the necessary tools to effectively manage their disease in order to improve their quality of life and the medical care they receive. This is a formidable challenge, considering limited amount of time allotted for patient visits and the limited availability of pulmonary rehabilitation programs nationwide, both of which are compounded by reimbursement problems.