Editor—Campbell and McGauley share insights from forensic psychiatry about the relationship between doctor and patient in chronic illness.1 Their observations have relevance to a new and emerging issue in chronic care: the transition of young adults with chronic conditions from child centred (paediatric) to adult oriented health care.
Some young adults and families experience “culture shock” when transferring from paediatric to adult care.2 Paediatrics is seen as supportive and compassionate, whereas adult care is perceived as formal, businesslike, distant, rigid in therapeutic approach, and less interested in patients' perspectives. Campbell and McGauley's description of “negative” attitudes of the adult system towards patients with “incurable” conditions supports this notion of a difference in the culture of paediatrics and adult medicine. They also give guidance to adult providers who take over care of young adults regarding the importance of building a positive relationship with their patient; eliciting patients' perspectives on the illness; and developing flexible, individualised treatment plans.
Adult providers need to be aware that new young adult patients have ended what may have been a long term psychologically important relationship with paediatric providers and may need to help young adults achieve a sense of closure with previous providers before they can develop a positive relationship with new adult providers.
Campbell and McGauley focused their discussion on the patient as an individual. I suggest that those caring for patients with chronic conditions view the family, rather than the patient, as the unit of care. Relationships between families and doctors in chronic illness are especially important since the patient's “significant others” (spouse, children, parents, extended family) can have a major role in promoting adherence to the therapeutic regimen, monitoring health status, and identifying exacerbations of the chronic condition.