One of the many things that Ara Darzi got right in his 2008 report was the importance of care planning for people with long term conditions. The crucial issue if you have a long term condition is the very specific way in which the disease interacts with you and your life. Having asthma or depression affects you in different ways from me. Your body has different lungs for coping with asthma and might also react to depression in a different way.  And your mind will deal with the stresses of both conditions in a different way from mine. Your life, your friends and your family will give and take different things from you. Of course given the millions suffering from these conditions, there are patterns but each sufferer also needs to be understood as an individual – differing from patient to patient.

The best person to develop that understanding is the patient themselves. They know the answers to most parts of most questions about their condition – and many more besides. The problem is for many patients that the answers they have to what are very detailed questions are developed between themselves and their family and stay within this milieu. “My joints are bad in the spring and in the morning”; “generally I feel much less depressed on a Friday than the rest of the week”; “my knees respond well to walking up ten flights of stairs regularly, but four gives me a lot of pain”; “my depression seems to lift when I can get out of the house every other day, but every day seems too much”. Whilst this knowledge may be shared with the doctor on one or two occasions, the patient has these experiences every week.