For patients with chronic disease, it can be the one where it’s all going right, treatment has worked, goals are met, and we are entering that “maintenance phase”.

That might be when the Type 2 Diabetes is in remission: blood sugars are under control and we have been able to stop medication. Or the orthopaedic surgeon is happy that the patient has achieved a healthy weight to look after their joint health. Or the patient’s cardiologist has been delighted with the improvement in cholesterol and blood pressure. It’s all going great. The goals have been met.

That’s all good, isn’t it? Sometimes yes – sometimes, no.

That stress as we enter maintenance phase may be real and well-founded and very rational: what if the blood pressure goes back up? What if the diabetes comes out of remission? What if the weight comes back? This can be very real in patients who have had lived experience of weight cycling (repeated weight loss and gain due to dieting, for example).

One of the most important conversations entering maintenance phase is to discuss the worries. And I encourage my patients to make an active and specific planan with me to maintain the health gains, and agree on how we will work together to keep an eye on things (including options like remote and/or blind monitoring), and we make an agreement when and how the patient will reach out early if things are changing.

Ideally, confidence in the sustained health gains will grow with time. Ideally, everything goes well. And if it doesn’t, it’s okay to be disappointed. I encourage patients to be positive and optimistic that everything should continue to be fine – if preventative medicine didn’t work, docs wouldn’t do it. Evidence-based medicine means we know what works. That said, things can go wrong – even if the patient “does everythign right” and it’s important not to blame themselves. That’s why we’ll have a plan.

Stopping medication is a thing?  Yes, and docs love to do it. 

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