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The relationship between a doctor and a patient is an important factor in the treatment of illness. Both the doctor and the patient share a responsibility in the management of asthma. Except for those living in sparsely populated rural areas, most people are able to choose their doctor, particularly their general practitioner.The GP is usually the primary care medical professional in the treatment and management of asthma. It is common for a GP to refer patients to a specialist for specific tests and further assessment, but it is normally the GP with whom the patient has the most contact.Choosing your GP is an important decision. If possible, it is best to have a doctor whom you respect and trust professionally as well as like personally. A mutually respectful and trusting relationship between a doctor and patient makes communication easier, helping the patient feel comfortable in discussing personal health problems and helping the doctor diagnose problems more readily.As the severity and symptoms of asthma can vary from person to person, it is important to have a doctor who is able to recognize and diagnose asthma, is cognizant and up to date with available medications, and who will spend the necessary time working out a management plan for each patient. A patient should also ask for an action plan that can be implemented in the event of an acute attack.Unfortunately the ideal is not always the reality. You may not live in an area where there are enough available doctors to choose from. This can be a particular problem for asthmatics living in rural communities. It is particularly important for such people to have a good management plan and know how to self-medicate.While asthma education for both doctors and patients is improving, asthma is still poorly treated in the community and the information given to patients by doctors is often inadequate and incomplete. This was certainly true for Sonia, 58, when she sought a new GP:I don’t have a car, so I went to the doctor nearest my home. I began to realize that he did not know much about asthma after he prescribed ten courses of antibiotics for my wheezing over a four-month period. I also had Ventolin, but my asthma got worse. Finally I went to the out-patients clinic at a hospital, saw a specialist and my treatment was changed. I am now on Becotide as well as Ventolin and am much better. The specialist advised me to get a peak flow meter and I use it twice a day to monitor my breathing. I also go back to the hospital for regular reviews. The specialist at the hospital said he has written to my GP, but so far I have not been back to see him. Now that I am feeling better, I feel more confident, so perhaps I can discuss my medication with the GP without feeling I am telling him what to do.There is still a serious communication gap between many doctors and their patients. This can be the fault of either. Doctors have a responsibility — but so do patients. Doctors are not trained communicators or educators and some have to deal with difficult and obtuse patients who don’t reveal all their symptoms, take their medication erratically and often take more notice of what unqualified people tell them than the advice given by their doctors. Most doctors have a few horror stories to tell about self-treatment.Many doctors do not appear to allow sufficient time to explain the disease and the management of asthma to the patient. A competent doctor should be able to give the patient and their family a thorough and realistic explanation of asthma and how to manage it effectively.The National Asthma Campaign has produced The Asthma Management Plan, a booklet which has been distributed to doctors and medical students. The publication provides doctors with:•An endorsed asthma management plan in a form that can be used both as a reference and as a teaching tool;•A consistent terminology for both doctor and patient to use;•Check points to help ensure comprehensive management. The National Asthma Campaign’s Management Plan provides a framework within which doctors and patients can work together. It engenders a new and better doctor/patient relationship and encourages patients to take more responsibility for their health and asthma management. Initiatives such as this booklet are addressing many of the perceived problems in asthma treatment and doctor/patient relationships.Most State Asthma Foundations offer a telephone service to help the public with questions and problems about asthma treatment, medication and management.QUESTIONS TO CONSIDER WHEN CHOOSING YOUR DOCTOR:Are you comfortable and at ease with your doctor, and can you discuss your health problems openly?Does your doctor respect your views and your confidentiality?Does your doctor adequately explain what is happening and what treatment to expect?4- Does your doctor spend enough time with you?Does your doctor prepare you for possible side effects of the prescribed medication?Do you feel that you are participating in your general health care and asthma management plan?Does your doctor show displeasure if you suggest a second opinion? (A patient has a right at all times to obtain a second opinion from another doctor regarding any aspect of health.)A visit to your doctor is often more productive if you write down all your questions and observations of symptoms beforehand.*46\148\2*

In Older Children (10-15 years). The goals for asthma self-management, for older children should be:
Allow the child to become an ally of the physician.
To make your child live as normal a life as possible.
To increase his confidence in his ability to manage the illness by himself.
A child can achieve this by learning to manage the triggers, thereby controlling the attacks, and by learning to manage his medication.
Making the child an ally of the Physician. An important aspect of self-management is that an asthmatic child should be taught to observe and record the triggers that affect him. Since it is he, more than anyone else, knows what triggers the attack; the sensations that occur during an attack, and what controls the attack. The child should be encouraged to share his experiences with the physician. This will help the physician help the child better.
Leading a normal life. Sometimes, asthma may become the centre of the child’s life. He may find it difficult to do many things like taking part in outdoor activities for fear of triggering an attack. The child should be encouraged to use self-management skills, limit the frequency and severity of the attacks and lead a normal life.
Confidence. A child who takes an active role in his own care will develop the confidence necessary to tackle the disorder. And this is very important to control individual episodes of asthma.
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